Anomalous coronary arteries: Difference between revisions
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==Background== | ==Background== | ||
*Coronary arteries arise from the truncus arteriosus as endothelial buds, during this process abnormal involution, bud positioning, or septation of the truncus arteriosus may lead to abnormal origin of the coronary arteries | *Coronary arteries arise from the truncus arteriosus as endothelial buds, during this process abnormal involution, bud positioning, or septation of the truncus arteriosus may lead to abnormal origin of the coronary arteries | ||
*Symptoms occur due to the path that these arteries take to supply the heart, some coursing between the aorta and pulmonary arteries which results in compression, or taking abrupt turns causing acute angles that are predisposed to obstruction | *Symptoms occur due to the path that these arteries take to supply the heart, some coursing between the aorta and pulmonary arteries which results in compression, or taking abrupt turns causing acute angles that are predisposed to obstruction | ||
*Incidence is 0.64% of births | |||
===Types=== | |||
*Left circumflex from right sinus of valsalva | |||
*Single coronary artery from the left sinus of valsalva | |||
*Both coronary arteries from the right sinus of valsalva | |||
*LAD from the right sinus of valsalva | |||
==Clinical Features== | ==Clinical Features== | ||
*Anginal chest pain | *Anginal [[chest pain]] | ||
*Syncope | *[[Syncope]] | ||
*Sudden death | *Sudden death | ||
**In one study accounted for 13% of cases of sudden death in competitive athletes <ref>Relationship of race to sudden cardiac death in competitive athletes with hypertrophic cardiomyopathy. AU Maron BJ, Carney KP, Lever HM, Lewis JF, Barac I, Casey SA, Sherrid MV SO. J Am Coll Cardiol. 2003;41(6):974</ref> | **In one study accounted for 13% of cases of sudden death in competitive athletes <ref>Relationship of race to sudden cardiac death in competitive athletes with hypertrophic cardiomyopathy. AU Maron BJ, Carney KP, Lever HM, Lewis JF, Barac I, Casey SA, Sherrid MV SO. J Am Coll Cardiol. 2003;41(6):974</ref> | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{DDX syncope peds}} | |||
{{DDX CP peds}} | |||
==Evaluation== | ==Evaluation== | ||
*EKG | *[[EKG]] | ||
*CXR | *[[CXR]] | ||
*Troponin | *[[Troponin]] | ||
*[[Echocardiography]] | |||
*Noninvasive coronary magnetic resonance angiography (CMRA) | |||
**The best option if available | |||
*Coronary angiography | |||
==Management== | ==Management== | ||
| Line 39: | Line 34: | ||
==Disposition== | ==Disposition== | ||
*Cardiology consult | *Cardiology consult | ||
==See Also== | |||
==External Links== | |||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category: Cardiology]] | [[Category: Cardiology]] | ||
[[Category: Pediatrics]] | [[Category: Pediatrics]] | ||
Latest revision as of 12:24, 14 May 2022
Background
- Coronary arteries arise from the truncus arteriosus as endothelial buds, during this process abnormal involution, bud positioning, or septation of the truncus arteriosus may lead to abnormal origin of the coronary arteries
- Symptoms occur due to the path that these arteries take to supply the heart, some coursing between the aorta and pulmonary arteries which results in compression, or taking abrupt turns causing acute angles that are predisposed to obstruction
- Incidence is 0.64% of births
Types
- Left circumflex from right sinus of valsalva
- Single coronary artery from the left sinus of valsalva
- Both coronary arteries from the right sinus of valsalva
- LAD from the right sinus of valsalva
Clinical Features
- Anginal chest pain
- Syncope
- Sudden death
- In one study accounted for 13% of cases of sudden death in competitive athletes [1]
Differential Diagnosis
Syncope (peds)
- Seizure
- Breath-holding spell
- Hyperventilation syndrome
- Pregnancy (especially ectopic)
- Hypoglycemia
- Cardiac disease
- Toxicologic exposure (stimulants or depressant)
Chest pain (peds)
- Idiopathic (most common)
- Precordial catch syndrome
- Sudden, intense pain with deep inspiration, self-resolving
- Usually located to one finger point and the intercostal space (often at apex of heart)[2]
- Musculoskeletal
- Pulmonary
- Pneumothorax
- Pneumonia (peds)
- Pulmonary embolism
- Aortic dissection
- Uncommon but consider with history of connective tissue disease
- GI
- Psychosomatic
- Cardiac (1%)
- Left-sided obstructive lesions
- Dysrhythmias
- HOCM
- Pericarditis
- Prinzmetal's angina (vasospasm)
- MI
- Rare, even post-Kawasaki
- Consider coronary artery dissection
- Mitral valve prolapse
- Anomalous coronary arteries]
Evaluation
- EKG
- CXR
- Troponin
- Echocardiography
- Noninvasive coronary magnetic resonance angiography (CMRA)
- The best option if available
- Coronary angiography
Management
- Definitive treatment is surgery
Disposition
- Cardiology consult
See Also
External Links
References
- ↑ Relationship of race to sudden cardiac death in competitive athletes with hypertrophic cardiomyopathy. AU Maron BJ, Carney KP, Lever HM, Lewis JF, Barac I, Casey SA, Sherrid MV SO. J Am Coll Cardiol. 2003;41(6):974
- ↑ Pickering D. Precordial catch syndrome. Arch Dis Child. 1981;56(5):401-403. doi:10.1136/adc.56.5.401