Best Practice Case Studies-Coronary Artery Anomalies

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Coronary artery anomalies (CAAs) are congenital cardiovascular conditions characterized by the abnormal origin or pathway of any of the three main epicardial coronary arteries. CAAs, often found incidentally during diagnostic procedures for ischemic heart diseases, hold clinical significance due in part to their association with sudden cardiac death (SCD) in young athletes. While CAAs are frequently identified in adults using advanced imaging techniques, their clinical consequences and progression remain largely uncertain, and therapeutic guidelines are based on limited evidence.<br /><br />CAAs can be classified by anomalies of origin, course, or termination. Anomalies of origin include those arising from the pulmonary artery or the opposite aortic sinus, which may increase the risk of SCD especially in the presence of specific anatomical features like an interarterial course or a slit-like ostium. Anomalies of course like myocardial bridging may occasionally lead to ischemia or adverse cardiac events. Anomalies of termination, such as coronary arteriovenous fistulas, can result in complex pathophysiology depending on their severity.<br /><br />Diagnosing CAAs often requires imaging modalities like coronary computed tomography angiography (CCTA) for anatomical evaluation, coupled with functional tests to determine the presence of myocardial ischemia. Treatment approaches are varied, ranging from observational management to surgical interventions depending on the specific anomaly and its symptomatic manifestations.<br /><br />The management of CAAs remains challenging due to insufficient data supporting specific treatment protocols and the complex nature of these anomalies. Evaluative functional tests for myocardial ischemia are advised, yet whether the absence of inducible ischemia guarantees a low risk profile remains an unresolved question. Current guidelines suggest exercise restrictions for affected individuals, underscoring the need for cautious approach in those with CAAs particularly if they engage in competitive sports. The field calls for more robust, prospective studies to better understand the implications of CAAs and refine therapeutic strategies.

Meta Tag

Edition 3rd Edition

Related Case 3rd Edition, CASE 08

Topic Cardiac

Keywords

3rd Edition, CASE 08

3rd Edition

Cardiac

Coronary artery anomalies

Congenital cardiovascular conditions

Sudden cardiac death

Young athletes

Imaging techniques

Myocardial ischemia

Surgical interventions

Exercise restrictions

Therapeutic guidelines

Prospective studies