hrvatski

Coronary artery anomalies in the elderly – a case report

Introduction: Coronary artery anomalies (CAA) are congenital anomalies that affect the coronary vessel origin, their anatomy and histologic structure with the prevalence in the general population between 0.5-2%. The most common subgroup of CAA are the anomalies of the vessel origin and direction. Most patients are asymptomatic for a large portion of their lives, although the first clinical symptom may be sudden death. There are 3 treatment options: medical treatment/ observation, coronary angioplasty with stent deployment, and surgical repair.1-3 We report a patient with anomalous origin of the left coronary artery (LCA) who presented with chest pain and was treated conservatively. Case report: 71-years-old female arrived at the Emergency Department complaining of an intermittent retrosternal chest pain and dyspnea during the last 7 days. Her blood pressure was also higher for the last 7 days, up to 200 mmHg in systole. She performed an unremarkable exercise testing and a nuclear stress testing which showed inferolateral, posterolateral, apicoseptal and inferoposterior hypoperfusion. The physical examination was unremarkable. ECG showed sinus bradycardia with ventricular premature beats. She was prescribed a bisoprolol, trimetazidine, nitrate, amlodipine, statin and aspirin. Six months later, she performed coronary angiography which showed an anomalous origin of LCA from the right Valsalva sinus. She was referred to a MSCT coronarography which confirmed the finding. RCA was free of pathomorphologic changes. ACx was a dominant artery, while LAD was gracile, without stenotic lesions. On follow-up visit after three months, the patient was free of chest pain. The last follow-up visit was three years later, and the patient is still asymptomatic. Conclusion: The main finding of this case report consisted of a LCA emerging from the right Valsalva sinus without anomalous features of other coronary arteries. The elderly patient presented with atypical chest pain and was treated conservatively, with a combination of beta-blocker and anti-ischemic agents, trimetazidine and nitrate, in order to provide the decompression of the vessel between aorta and pulmonary artery.

Anomalije koronarnih arterija, stariji bolesnici

nije evidentirano

engleski

Coronary artery anomalies in the elderly – a case report

Introduction: Coronary artery anomalies (CAA) are congenital anomalies that affect the coronary vessel origin, their anatomy and histologic structure with the prevalence in the general population between 0.5-2%. The most common subgroup of CAA are the anomalies of the vessel origin and direction. Most patients are asymptomatic for a large portion of their lives, although the first clinical symptom may be sudden death. There are 3 treatment options: medical treatment/ observation, coronary angioplasty with stent deployment, and surgical repair.1-3 We report a patient with anomalous origin of the left coronary artery (LCA) who presented with chest pain and was treated conservatively. Case report: 71-years-old female arrived at the Emergency Department complaining of an intermittent retrosternal chest pain and dyspnea during the last 7 days. Her blood pressure was also higher for the last 7 days, up to 200 mmHg in systole. She performed an unremarkable exercise testing and a nuclear stress testing which showed inferolateral, posterolateral, apicoseptal and inferoposterior hypoperfusion. The physical examination was unremarkable. ECG showed sinus bradycardia with ventricular premature beats. She was prescribed a bisoprolol, trimetazidine, nitrate, amlodipine, statin and aspirin. Six months later, she performed coronary angiography which showed an anomalous origin of LCA from the right Valsalva sinus. She was referred to a MSCT coronarography which confirmed the finding. RCA was free of pathomorphologic changes. ACx was a dominant artery, while LAD was gracile, without stenotic lesions. On follow-up visit after three months, the patient was free of chest pain. The last follow-up visit was three years later, and the patient is still asymptomatic. Conclusion: The main finding of this case report consisted of a LCA emerging from the right Valsalva sinus without anomalous features of other coronary arteries. The elderly patient presented with atypical chest pain and was treated conservatively, with a combination of beta-blocker and anti-ischemic agents, trimetazidine and nitrate, in order to provide the decompression of the vessel between aorta and pulmonary artery.

Coronary artery anomalies, elderly

nije evidentirano