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Anomalous Coronary Artery — EECC MCQ

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ModerateCoronary Artery DiseaseAnomalous Coronary ArteryEECC

A 50-year-old man with stable angina is found to have a coronary artery anomaly: the right coronary artery arises from the left coronary sinus with an interarterial course between the aorta and pulmonary artery. He plays recreational football. What is the main concern?

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Correct answer: B — Risk of sudden cardiac death during exercise due to dynamic compression of the anomalous coronary artery between the great vessels

A coronary artery arising from the opposite sinus with an interarterial (between aorta and PA) course is a potentially malignant coronary anomaly. During exercise, the aorta and pulmonary artery dilate and can dynamically compress the anomalous segment, causing myocardial ischaemia and potentially fatal ventricular arrhythmias. This is a recognised cause of exercise-related SCD in young athletes. The 2020 ESC Sports Cardiology Guidelines recommend restriction from competitive sport and referral for further assessment (stress imaging, CCTA to characterise the course, and potentially surgical correction — unroofing or reimplantation). The interarterial course (not intramural or retro-aortic) is the key high-risk feature.

Reference: ESC (2020): Sports Cardiology Guidelines; AHA Scientific Statement on Coronary Anomalies