This document discusses the case of a 24-year-old male who presented to the emergency ward with chest pain. Though initially diagnosed with gastroesophageal reflux, further examination revealed he had an anomalous right coronary artery arising from the left coronary cusp with an intra-arterial course between the aorta and pulmonary artery. This rare coronary anomaly has a prevalence between 0.026-0.25% and can cause arrhythmias, syncope, myocardial infarction, and sudden cardiac death. The document emphasizes that young patients presenting with symptoms like chest pain and no known risk factors are more likely to have underlying structural heart issues rather than traditional risk factors.

1. ARCA IN DISGUISE OF MI
INTRODUCTION
Young patients with age
below 30years without other
risk factors are thought to be
at very low risk of coronary
artery disease and acute
coronary syndromes.
CASE
The overall 24year old male
with no comorbidities,non
smoker presnted to
emergency ward following
episode of chest pain.The
pain was retrosternal
location,burning sense,non
radiating not associated with
nausea,vomiting,more tha
15minutes.i had been to
general practitioners 1 week
prior with a similar complaint
and diagnosed with
gatroesophageal
reflux(GERD).
Vitals were stable with bp-
130/80mmhg,pulse80bpm,re
minaining.physical
examination were normal.
DR SRINIVAS B. DR.SADANAND I.
NIZAM’S INSTITUTION OF MEDICAL SCIENCES
DISCUSSION:
coronary anomaliesare found in
0.2-1.2%of the population.origin
of anamalous RCA arising from
left coronary cusp with intra-
arterial course between the aorta
and pulmonary artery has
prevalence of of 0.026%-0.25%
.associated with arrhythmia
syncope myocardial infarction
,sudden cardiac death.
Exact mechanism of remains
unclear.proposed hypotheses are
1.mechanical compression of the
coronary artery between
pulmonary artery and aorta
2.Acute take off angle at the
ostium of the rca and left
coronary sinus
3.Abnormal slit like RCA orifice in
aortic wall
REFFERENCES
-1. White NK, Edwards JE. Anomalies of the
coronary arteries. Report of four cases. Arch
Pathol 1948;45:766–71
TAKE HOME MESSAGE
Young patients with no
known comorbidities are
more likely to have the
structural heart disease to
cause myocardial infarction