coronary artery anomaly

A coronary artery anomaly (CAA) is a defect in one or more of the coronary arteries of the heart, present at birth [4]. It refers to abnormalities involving the origin, course, and structure of the three main epicardial coronary arteries [7].

There are various types of CAA, including:

• Anomalies of the origin: where the coronary artery arises from an unusual location, such as the pulmonary artery instead of the aorta [1].
• Congenital coronary stenosis: a rare anomaly characterized by significant tightening or occlusion of a coronary artery [2].
• Abnormal course or termination: where the coronary artery takes an abnormal path or ends in an unusual location.

These anomalies can affect one or both coronary arteries and may occur along with other congenital heart defects. In some cases, CAAs can cause severe reduction of blood flow to the myocardium (ischaemia), leading to chest pain, arrhythmias, and sudden cardiac death [3].

The prevalence of CAA varies, but it is estimated to occur in 0.3-0.9% of the population without structural heart defects and in 3-6% of those with congenital heart defects [13]. Early detection and evaluation are essential due to their potential association with myocardial ischemia and sudden death.

References:

[1] Normally, the right coronary artery comes out of the right aortic sinus of Valsalva. Similarly, the left coronary artery comes out of the left aortic sinus of Valsalva. A coronary artery that starts from the pulmonary artery instead of the aorta is another type of anomaly.

[2] Congenital coronary stenosis is another rare anomaly, characterized by a significant tightening—up to complete occlusion or atresia—of a coronary artery.

[3] Core tip: Congenital coronary artery anomalies are not common, but it is crucial to identify them as in some cases they can cause severe reduction of blood flow to the myocardium (ischaemia) and lead to chest pain, arrhythmias and sudden cardiac death, and that in themselves can increase the risk of routine procedures.

[4] A coronary artery anomaly (CAA) is a defect in one or more of the coronary arteries of the heart. The defect is congenital (present at birth).

[7] by P Angelini · 2007 · Cited by 1085 — The basic definition of an anomalous coronary artery proposed by Angelini and colleagues is based on the relative frequency of anatomical variations.

[13] Coronary artery anomalies occur in 0.3–0.9% of the population without structural heart defects and in 3–6% of those with congenital heart defects.

Symptoms of Coronary Artery Anomaly

Coronary artery anomaly, also known as anomalous coronary artery (ACA), can manifest in various ways depending on the type and severity of the condition. Here are some possible signs and symptoms:

• No symptoms at all: In many cases, people with ACA may not experience any noticeable symptoms, especially if the anomaly is mild or does not affect blood flow to the heart muscle.
• Chest pain or discomfort: Some individuals may experience chest pain or discomfort during physical exertion, which can be a sign of reduced blood flow to the heart muscle.
• Shortness of breath: Trouble breathing or feeling winded even when sitting still can be an early warning sign of ACA.
• Fainting or dizziness: In some cases, people with ACA may experience fainting spells (syncope) or feel dizzy during physical activity due to reduced blood flow to the brain.
• Abnormal heart rhythms: Anomalous coronary arteries can lead to abnormal heart rhythms (arrhythmias), which can be a sign of underlying cardiac issues.

Other possible symptoms

In some cases, ACA may cause additional symptoms, such as:

• Blue or purple tint to gums, tongue, skin, and nails (cyanosis)
• Poor eating and weight gain
• Crying with feeds (in infants)
• Rapid breathing

It's essential to note that these symptoms can be similar to those experienced by people with other heart conditions. If you're experiencing any of these symptoms, it's crucial to consult a healthcare professional for proper evaluation and diagnosis.

References

[1] Anomalous coronary artery symptoms may differ based on the type of anomaly. Many children don’t have symptoms of anomalous aortic origin of a coronary artery (AAOCA) from opposite sinus of Valsalva. Sudden cardiac arrest or sudden cardiac death during exertion may be the first sign of it. [1] [4] Anomalous coronary artery may not cause any symptoms. Or it may cause symptoms such as chest pain or fainting with exercise, or abnormal heart rhythms. [4] [7] Any symptoms during or immediately after exertion, such as chest pain, shortness of breath, fainting (syncope), feeling faint (near syncope) or palpitations... [7] [11] Both chest pain and heart failure symptoms serve as early warning signs in adults that the heart muscle is no longer receiving sufficient blood supply from the coronary artery circulation, which may have been adequate during infancy and childhood. The symptoms of an anomalous coronary artery may resemble other medical conditions or heart problems. [11]

Please consult a healthcare professional for proper evaluation and diagnosis if you're experiencing any of these symptoms.

Diagnostic Tests for Coronary Artery Anomaly

Coronary artery anomalies (CAAs) can be challenging to diagnose, but various tests can help identify these conditions. Here are some diagnostic tests used to diagnose CAAs:

• Imaging tests: These include echocardiography, invasive coronary angiography (ICA), and coronary computed tomography angiography (CCTA). These tests can help visualize the coronary arteries and detect any anomalies.
  • Echocardiography: This non-invasive test uses sound waves to create images of the heart and its blood vessels. It can identify CAAs, but may not always provide a clear picture [1].
  • ICA: This invasive test involves inserting a catheter into an artery in the leg or arm and guiding it to the coronary arteries. It provides detailed images of the coronary arteries and can detect CAAs [2].
  • CCTA: This non-invasive test uses computed tomography (CT) scans to create detailed images of the coronary arteries. It is often used as a first-line imaging test for patients with suspected CAA [3].
• Other tests: These include physical examination, electrocardiogram (ECG), and blood tests.
  • Physical examination: A doctor may perform a physical examination to look for signs of heart disease or other conditions that can be related to CAAs [4].
  • ECG: This test measures the electrical activity of the heart and can detect abnormal rhythms or patterns that may indicate CAA [5].
  • Blood tests: These can help rule out other conditions that may cause similar symptoms, such as high cholesterol or blood sugar levels [6].

It's essential to note that some people with CAAs may not have any symptoms or physical findings during a physical examination. In these cases, imaging tests and other diagnostic procedures are crucial for accurate diagnosis.

References:

[1] Search result 1: "Imaging and functional tests to diagnose coronary artery anomalies (CAAs) and assess myocardial ischemia."

[2] Search result 2: "With the increasing application of coronary computed tomography angiography (CCTA) as the standard of care for patients with acute chest pain,

Treatment Options for Coronary Artery Anomaly

Coronary artery anomalies (CAAs) are a group of congenital conditions characterized by abnormal origin or course of any of the 3 main epicardial coronary arteries. While there is no specific "drug treatment" for CAAs, certain medications may be used to manage symptoms and complications associated with these anomalies.

• Medications for symptom management: In some cases, patients with CAAs may experience symptoms such as chest pain or shortness of breath. Medications like digoxin, diuretics, blood pressure lowering medicines, and/or blood thinners may be prescribed to alleviate these symptoms [9].
• No specific medication for CAA: However, it's essential to note that there is no specific "drug treatment" for CAAs themselves. The primary treatment approach for CAAs often involves surgical intervention or other interventional procedures to address the underlying anatomical issue.

Surgical and Interventional Options

For patients with CAAs, treatment may involve:

• Surgery: Surgical reimplantation of the anomalous artery has become a preferred procedure in some cases [7].
• Other interventional procedures: Treatment for CAAs may also include other interventions such as strengthening the heart, oxygen therapy, and activity limitations.

References

[9] Symptoms are often treated with medicines such as digoxin, diuretics, blood pressure lowering medicines, and/or blood thinners. If the damage is very severe, surgery might be required. [7] Reimplantation of the anomalous artery has become our procedure of choice. The LCA can almost always be mobilized to reach the aorta without tension.

Differential Diagnosis of Coronary Artery Anomaly

Coronary artery anomalies (CAAs) are a group of congenital conditions characterized by abnormal origin or course of any of the 3 main epicardial coronary arteries. When diagnosing CAAs, it is essential to consider various differential diagnoses that can mimic or coexist with these anomalies.

Listed below are some of the key differential diagnoses for coronary artery anomaly:

• Coronary artery atherosclerosis: This condition involves the buildup of plaque in the coronary arteries, leading to narrowing and potential blockage. It is more common than CAAs and can cause similar symptoms.
• Dilated cardiomyopathy: A condition where the heart muscle becomes weakened, leading to poor pumping function and potentially causing myocardial ischemia.
• Hypertrophic cardiomyopathy: A condition characterized by thickening of the heart muscle, which can lead to obstruction of blood flow and potential myocardial ischemia.
• Myocardial ischemia: This refers to a condition where the heart muscle does not receive enough oxygen-rich blood, leading to chest pain or discomfort.
• Pulmonary embolism: A blockage in one of the pulmonary arteries, which can cause sudden onset of chest pain and shortness of breath.
• Valvular disease: Abnormalities in the heart valves, such as stenosis or regurgitation, can lead to symptoms similar to those caused by CAAs.

According to [2], differential diagnosis includes tortuous collaterals developed between a patent and an obstructed vessel.

In addition to these conditions, it is also essential to consider other factors that may contribute to the presentation of coronary artery anomalies, such as:

• Anatomical variations: The presence of anatomical variations in the coronary arteries can make diagnosis more challenging.
• Collateral circulation: The development of collateral blood vessels can provide an alternative route for blood flow and potentially mask symptoms.

References:

[1] by MB Malik · 2023 · Cited by 2 — Differential Diagnosis

[2] by F Raimondi · 2016 · Cited by 20 — The differential diagnosis is with an ectopic coronary artery origin, particularly from the pulmonary artery which is considerably more common or extreme