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      Myocardial Ischemia Caused by Paroxysmal Supraventricular Tachycardia in a Patient with Anomalous Origin of Right Coronary Artery Arising from Left Sinus of Valsalva

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          Abstract

          Anomalous origin of a coronary artery is rare and does not generally lead to myocardial infarction and paroxysmal supraventricular tachycardia (PSVT). We report an uncommon case of anomalous origin of the right coronary artery (RCA) originating from the left sinus of Valsalva with PSVT and myocardial ischemia. A 58-year-old man presented with PSVT. After arrhythmia subsided, electrocardiogram showed ST and T wave abnormalities, and transient cardiac enzymes were found to be elevated. Coronary CT angiography confirmed that there was anomalous origin of the RCA originating from the left sinus of Valsalva and no intracoronary stenotic lesion. He was managed with conservative treatment, having no symptoms on clinical follow-up for 4 years.

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          Coronary artery anomalies in 126,595 patients undergoing coronary arteriography.

          O Yamanaka, R. E. Hobbs (1990)
          Coronary artery anomalies were found in 1,686 patients (1.3% incidence) undergoing coronary arteriography at the Cleveland Clinic Foundation from 1960 to 1988. Of the 1,686 patients, 1,461 (87%) had anomalies of origin and distribution, and 225 (13%) had coronary artery fistulae. Most coronary anomalies did not result in signs, symptoms, or complications, and usually were discovered as incidental findings at the time of catheterization. Eighty-one percent were "benign" anomalies: 1) separate origin of the left anterior descending and circumflex from the left sinus of Valsalva; 2) ectopic origin of the circumflex from the right sinus of Valsalva; 3) ectopic coronary origin from the posterior sinus of Valsalva; 4) anomalous coronary origin from the ascending aorta; 5) absent circumflex; 6) intercoronary communications; and 7) small coronary artery fistulae. Other anomalies may be associated with potentially serious sequelae such as angina pectoris, myocardial infarction, syncope, cardiac arrhythmias, congestive heart failure, or sudden death. Potentially serious anomalies include: 1) ectopic coronary origin from the pulmonary artery; 2) ectopic coronary origin from the opposite aortic sinus; 3) single coronary artery; and 4) large coronary fistulae. Coronary artery anomalies require accurate recognition, and at times, surgical correction.
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            Coronary anomalies: incidence, pathophysiology, and clinical relevance.

            J Velasco, Scott Flamm, Paolo Angelini (2002)
            Article 0 comments Cited 170 times – based on 0 reviews     Review now
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              Myocardial ischemia induced by rapid atrial pacing causes troponin T release detectable by a highly sensitive assay: insights from a coronary sinus sampling study.

              V. J. Martin, G. Lewis, Stephen Hillis … (2011)
              The purpose of this study was to assess whether: 1) very small increases in troponin T, measured by a new highly sensitive cardiac troponin T (hs-cTnT), may reflect ischemia without necrosis; and 2) serial changes can discriminate ischemia from other causes of cardiac troponin T (cTnT) release. A new hs-cTnT assay offers greater sensitivity than current assays. Nineteen patients referred for diagnostic catheterization underwent cannulation of the coronary sinus (CS). Serial CS and peripheral plasma samples were obtained at multiple time points during and after incremental rapid atrial pacing. cTnT was quantified using both a standard and a pre-commercial highly sensitive assay. Ischemia was determined by the presence of significant coronary artery disease (CAD) and myocardial lactate release with pacing. cTnT concentrations in CS blood increased from a median of 6.8 pg/ml prior to pacing to 15.6 pg/ml 60 min after termination of rapid atrial pacing (p < 0.0001), changes that were mirrored at 180 min in peripheral blood (5.1 to 11.8 pg/ml, p < 0.0001). Although peripheral cTnT concentrations tended to be higher at 180 min following pacing for patients with CAD and lactate elution (n = 7) when compared with those without either marker (n = 5) (25.0 pg/ml vs. 10.2 pg/ml, p = 0.10), relative (1.7-fold vs. 5.2-fold) and absolute (6.8 pg/ml vs. 8.8 pg/ml, p = 0.50) changes were not different between groups. Brief periods of ischemia, without frank infarction, cause low-level cTnT release, and small increases are common after periods of increased myocardial work, even among patients without objective evidence of myocardial ischemia or obstructive CAD. Additional research is needed before hs-cTnT assays are widely adopted in the management of subjects with chest pain syndromes. Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Korean Circ J
                Journal ID (iso-abbrev): Korean Circ J
                Journal ID (publisher-id): KCJ
                Title: Korean Circulation Journal
                Publisher: The Korean Society of Cardiology
                ISSN (Print): 1738-5520
                ISSN (Electronic): 1738-5555
                Publication date (Print): February 2013
                Publication date (Electronic): 28 February 2013
                Volume: 43
                Issue: 2
                Pages: 123-126
                Affiliations
                [1 ]Department of Internal Medicine, College of Medicine, CHA University, CHA Bundang Medical Center, Seongnam, Korea.
                [2 ]Cardiology Division, Department of Internal Medicine, College of Medicine, CHA University, Gangnam CHA Hospital, Seoul, Korea.
                [3 ]Cardiology Division, Department of Internal Medicine, College of Medicine, CHA University, CHA Bundang Medical Center, Seongnam, Korea.
                Author notes
                Correspondence: Yun Kyung Cho, MD, Cardiology Division, Department of Internal Medicine, College of Medicine, CHA University, Gangnam CHA Hospital, 566 Nonhyeon-ro, Gangnam-gu, Seoul 135-913, Korea. Tel: 82-2-3468-3282, Fax: 82-2-558-1119, yunkyung.cho@ 123456gmail.com
                Article
                DOI: 10.4070/kcj.2013.43.2.123
                PMC ID: 3596660
                PubMed ID: 23508331
                SO-VID: 073b2bb6-5394-4053-ae2e-6321da18d317
                Copyright © Copyright © 2013 The Korean Society of Cardiology
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 15 April 2012
                Date revision received : 20 June 2012
                Date accepted : 25 June 2012
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: coronary vessel anomalies,multidetector computed tomography,myocardial ischemia,tachycardia, paroxysmal
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: coronary vessel anomalies, multidetector computed tomography, myocardial ischemia, tachycardia, paroxysmal

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