Acute Inferior Myocardial Infarction with Anomalous Origin of the Right Coronary Artery, Myocardial Bridging and Fibro-Lipid Plaque.
Jun Shen, Yanming Wu, Biao Wang
✦ AI-curated · Sources linked
Case in brief
A 35-year-old man presented with sudden chest pain and clinical and electrocardiographic evidence of acute inferior myocardial infarction. Emergency angiography showed the right coronary artery (RCA) arising anomalously from the left coronary sinus, with a mid-RCA narrowing that persisted after intracoronary nitroglycerin. Intravascular ultrasound identified a 48% stenotic fibro-lipid plaque with a lipid core and thin fibrous cap; imaging also showed a deformed RCA ostium with a minimum luminal diameter of 2.14 mm and myocardial bridging. Symptoms resolved and recovery was uneventful with medical therapy and risk-factor control. Multidisciplinary evaluation for possible surgical management of the coronary anomaly was planned.
What made this case unusual
The infarction occurred in the setting of several potentially relevant findings in the same RCA: anomalous origin, ostial deformation with myocardial bridging, and an IVUS-defined fibro-lipid plaque. IVUS helped characterize the persistent mid-vessel narrowing beyond what angiography alone showed.
Diagnostic / clinical pearl
When a young patient with acute myocardial infarction has complex coronary anatomy and a lesion that persists after intracoronary nitroglycerin, IVUS can help distinguish and characterize plaque-related narrowing alongside congenital or dynamic abnormalities.