Objective: We present a case of a young man with multiple atherosclerotic risk factors and a rare cause of an-gina and supraventricular ectopic beats.
Case presentation: A 35- year-old man with one year history of stable angina pectoris and supraventricular ectopic beats, without any medication, was admitted in our hospital through emergency room with complain of anterior chest pain that occurs at moderate physical exertion. The rest electrocardiogram, transthoracic echocardiography and chest X-ray were normal; the exertion stress test was also normal, except supraventricular ectopic beats (trigeminal rhythm). Due to the intermediate pre-test probability of coronary artery disease, he was evaluated by coronary angio-CT. An anomalous origin of the right coronary artery from the left coronary sinus, with an interarterial course and without any atheroma plaques, was objected. During hospitalization, the evolution was stable without complications, under specific treatment for angina. At discharge it was recommended to address to cardiac surgery clinic to evaluate the possibility of surgical or interventional treatment of this anomaly.
Conclusions: Coronary artery anomalies are a very rare pathology, with multiple implications in current practice, including sudden death in young patients due to the malignant ventricular arrhythmias. Imaging dia-gnostic techniques allow for a rapid, non-invasive dia-gnosis of a rare cause of angina and arrhythmia.