Anomalous Origin of the Right Coronary Artery from the Left Coronary Sinus

A 41-year-old man with no relevant cardiac history presented for evaluation of episodic syncope. Electrocardiography showed sinus rhythm with right bundle-branch block and Q waves in leads II, III, and aVF. Subsequent exercise treadmill testing and technetium 99m sestamibi study revealed a reversible posterior defect. Coronary angiography later showed a right coronary artery that arose from the left coronary sinus—an anomaly that has been associated with angina, myocardial infarction, and sudden cardiac death. After being informed of the potential risks and options associated with this anomaly, the patient chose long-term β-blocker medical therapy. At follow-up, this treatment appeared to have resolved his episodic syncope. (Tex Heart Inst J 2002;29:37–9)