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ALCAPA — RACP Paediatrics MCQ

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HardCardiologyALCAPARACP Paediatrics

A 4-year-old presents with unexplained left ventricular dysfunction on echocardiogram. ECG shows deep Q waves in leads I, aVL, V5, V6. What diagnosis should be considered?

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Correct answer: A — Anomalous left coronary artery from pulmonary artery (ALCAPA)

ALCAPA (Bland-White-Garland syndrome) causes myocardial ischaemia as the coronary is perfused with desaturated blood at low pressure. ECG shows anterolateral ischaemia (deep Q waves, ST changes in I, aVL, V5-V6). Echocardiography may show LV dysfunction and mitral regurgitation. Surgical reimplantation of the coronary artery is curative.

Reference: RCH Melbourne – 2024 – Clinical Practice Guidelines: Coronary Artery Anomalies