Myocardial infarction with non-obstructive disease and anomalous coronary origin: look for the common in the uncommon

Management of congenital coronary artery anomalies (CAA) is not standardized due to the variety of conditions included and their rare prevalence. Detection of CM during myocardial infarction with non-obstructive coronary arteries (MINOCA) may induce clinicians to address the patient for surgery as CM is not included in any algorithm(1,2) for the management of MINOCA and American Association for Thoracic Surgery evidence-based guidelines suggest surgical repair for patients with anomalous aortic origin of a coronary artery and symptoms compatible with myocardial ischaemia.(3) We present the case of a 35-year-old man with an anomalous origin of left coronary artery from right Valsalva sinus with pre-pulmonic course detected during urgent coronary angiography for suspected myocardial infarction. Stress cardiac magnetic resonance did not show signs of ischaemia at high-dose dobutamine but did reveal a recent myocarditis. This clinical case highlights the need for accurate risk stratification in CM especially when confounding clinical scenarios co-exist.

Automated summary

Management of congenital coronary artery anomalies is not standardized, making it difficult to determine the appropriate treatment for patients. The detection of coronary malformations during myocardial infarction without obstructed arteries can lead to surgical intervention as it is not included in current management algorithms. This case highlights the importance of accurate risk stratification in coronary malformations, especially in complex clinical scenarios.