Coronary artery anomalies

The heart is a muscle and requires a regular supply of oxygen and nutrients to function. This is supplied by blood carried by two blood vessels known as the left and right coronary arteries. The arteries arise from the left and right side of the body’s main artery, the aorta. In up to 1% of people both coronary arteries originate on the same side of the aorta. This is called an anomalous coronary origin or coronary artery anomaly. The unusual origin of the artery means that the artery must take a different course to supply the heart muscle. In the majority of cases this causes no problems. However, in a small number of people the abnormal course can cause the anomalous coronary artery to be squashed or kinked during exercise. If the blood supply to the heart is interrupted it can cause a heart attack or the heart to beat in dangerous fast rhythms that can be fatal. The cause of coronary artery anomalies is not known, however they do not appear to be hereditary.

What are the symptoms?

Half of people with dangerous coronary artery anomalies experience warning symptoms including chest discomfort or blackouts that usually happen during physical exercise. In people who have symptoms the origin of the coronary arteries from the aorta should be investigated.

How is it diagnosed?

Screening for coronary artery anomalies remains challenging because electrocardiography (ECG) at rest and even during exercise is usually normal, even in individuals at high risk. This can often be done using echocardiography. If both arteries are not clearly seen during echocardiography, more detailed heart scans such as cardiac magnetic resonance imaging (MRI) or computed tomography (CT) can be used.

Treatment and advice

People with low risk anomalies can be treated with beta-blockers and are advised to avoid high levels of physical exertion. If high-risk anomalies are found surgery to re-implant the anomalous artery on the correct side of the aorta can be lifesaving.

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