Key Takeaways
A 37-year-old man experienced sudden cardiac arrest during sexual intercourse.
Physical examination and laboratory tests revealed no abnormalities. No heart murmurs were detected on auscultation, and the cardiac laboratory results were normal. ECG and transthoracic echocardiography showed no new findings. The diagnosis was confirmed using coronary CT angiography.
The patient was found to have a rare congenital anomaly — an anomalous origin of the right coronary artery (RCA) from the left coronary sinus, which is associated with an increased risk for myocardial ischaemia and sudden cardiac death during exertion. Cardiologist Dr Junchu Chang and colleagues from Xinyu People’s Hospital, China, detailed this rare cardiologic condition in a case report.
The Patient and His History
The patient presented to the emergency department after losing consciousness for 10-20 seconds during sexual intercourse. He reported experiencing occasional dizziness for approximately 10 years. His medical history included arterial hypertension and type 2 diabetes. He smoked but did not drink alcohol owing to an allergy. His family, medication, social, and travel histories were normal.
Clinical Findings
The patient’s vital signs were normal, with no abnormalities detected during examination, auscultation, palpation, percussion, or heart murmur assessment. Laboratory tests showed normal electrolyte levels, cardiac enzyme levels, coagulation parameters, blood glucose level, lipid levels, and liver and kidney function.
ECG revealed sinus rhythm without abnormalities. Bilateral carotid ultrasonography revealed no significant stenosis or plaque formation.
Transthoracic echocardiography revealed a normal ejection fraction of 60%, normal ventricular wall motion, and no signs of hypertrophic cardiomyopathy. MRI of the heart and brain showed no pathologic findings. However, CT angiography showed a rare coronary artery anomaly.
A stress ECG revealed ST depressions in leads II, III, and aVF (approximately 0.2-0.3 mV), but no chest pain or syncope was observed in the patient during transthoracic echocardiography. The test was terminated early because of low physical resilience.
Coronary CT angiography failed to visualise the RCA selectively, raising suspicion of an anomalous origin of the RCA. The patient was advised to undergo coronary CT angiography that confirmed the diagnosis: The RCA originated from the left coronary sinus.
Surgical intervention was recommended, given the patient’s symptoms after exertion and the anatomical variation. However, the patient opted for conservative management and agreed to modify his physical and sexual activities. At a 6-year follow-up visit, he reported no further cardiac arrests.
Discussion
“RCA originating in the left coronary sinus is a rare anomaly that can lead to serious cardiovascular complications in some patients due to the possibility of arterial compression or abnormal alignment during exertion,” the authors wrote.
The fact that conservative therapy was successful in the current case underlines “the value of an individualised approach to treatment.” In any case, the treatment and management of this rare coronary artery anomaly requires a comprehensive analysis of all accompanying circumstances.
This article was translated from Univadis Germany using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
