skip to main content

ALCAPA — RACP Paediatrics MCQ

Instant feedback + full explanation. One question, done properly.

HardCardiologyALCAPARACP Paediatrics

A 4-month-old presents with acute onset irritability, pallor, and sweating. ECG shows ST elevation in leads I, aVL, V5-V6 and deep Q waves in leads I and aVL. Troponin is markedly elevated. Echocardiogram shows severe LV dilatation with poor function. What is the most likely diagnosis?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Anomalous left coronary artery (ALCAPA)

ALCAPA (anomalous left coronary artery from the pulmonary artery) typically presents at 2-4 months of age with myocardial ischaemia/infarction as pulmonary artery pressure falls. ECG findings mimic anterolateral MI (Q waves in I, aVL, V5-V6). Echocardiography shows dilated LV with anterolateral wall motion abnormalities. Urgent surgical reimplantation is required.

Reference: RCH Melbourne – 2023 – Heart Failure CPG; RACP Paediatric Curriculum – Cardiology