Isolated Coronary Artery Anomaly : Types, Causes, Symptoms, Treatment, Diagnosis

Coronary Artery Anomaly is characterized by two ostia positioned in the right and left sinus of the Valsalva. The major left coronary artery starts from the left ostium that then branches in to the left anterior. The right coronary artery (RCA) start from the right ostium that provides an infundibular branch which leads to the anterior end of the heart. Considering the criticality is the debate of what could be considered as a normal state and what could be considered as a coronary artery anomaly. According to Angelini, Coronary Artery Anomaly is diagnosed in cases of abnormal Coronary Artery Morphology. The CAA is considered normal when the Coronary Artery Morphology is observed in less than one percent of the normal population. Coronary Artery Anomaly can be produced during normal or pathological cardiogenesis or other cardiac malformations.

Isolated Coronary Artery Anomaly is the condition where the patient does not have other major congenital defects in heart.

Coronary Artery Anomaly is less common than Coronary Artery Disease. These can be classified into the following types which are most significant:

• High Take Off: This is the origin of either the Right Coronary Artery or the Left Main Coronary Artery over the functional zone between its sinus and the tubular part of the ascending aorta.
• Multiple Ostia: This is when either the Right Coronary Artery or the bonus branch arises separately or the Left Anterior Descending Artery and the Left Circumflex Arteries arise separately.
• Single Coronary Artery: In this condition, only one Coronary Artery arises with a single ostium from the aortic trunk. This is an extremely rare condition.
• Myocardial Bridging: This is caused by a band of Myocardial Muscle overlaying a segment of the Coronary artery. This is mostly located in the segment of the Left Anterior Descending Artery.
• Duplication of Arteries: This has a short left anterior descending artery that moves and cuts down the anterior interventricular sulcus. This doesn’t reach the apex. further, left anterior descending artery start from either the RCA or the LAD artery proper.
• Coronary Artery Fistula: This is the condition that describe the communication between the coronary arteries.
• Coronary Arcade: This is a rare instance of communication which is large enough to be identified between the Right Coronary Artery and the Left Coronary Artery in the absence of Coronary Artery Stenosis.
• Extracardiac Termination: This is the connection which exists between the coronary arteries and Extracardiac vessels.

The symptoms differ which depends on the type of anomalous artery. Some of the forms have no symptoms while others show the following symptoms:

• Decreased blood flow in the tissues of the heart.
• Chest pain or exertion.
• Dizziness.
• Fainting.
• Heart failure.
• Shortness of breath.
• Fluid retention.
• Lesser flow of blood to the heart muscle.
• Damaged heart.

The majority of the Coronary Artery Anomaly have no known causes. This develops during infancy when a baby is just eight weeks and his heart is still developing. This is the root cause and hence appropriate steps should be taken in order to keep the heart at the place.

Coronary Artery Anomaly is a concern because there is no indication of the developing of these conditions unless it is severe. A person might not know about this condition until and unless there is chest pain, heart attack or even sudden death. Athletes and the persons who do strenuous activities are at the highest risk. This is the most common cause of death among young athletes. Coronary Artery Anomaly might pose a risk for earlier development of coronary atherosclerotic disease.

The doctor might suggest tests to monitor the heart and lungs performances and observe minutely to help in the better understanding of the conditions. Diagnosis test for Coronary Artery Anomaly varies by age, medical condition and other preferences. The diagnosis requires a high rate of supervision and, under specific circumstances. In patients over 35, a catheterization is usually performed since the higher incidence of atherosclerosis, leading to a suspicion of coronary artery disease.

Treatment of Isolated Coronary Artery Anomaly depends on the following factors:

• History, health and age of the patient
• Extent of Anomaly
• Tolerance of specific medications, procedures and therapies.
• Expectation for the course of defect.
• Personal preference.

Treatment of Isolated Coronary Artery Anomaly includes:

• Medical treatment which includes medication makes the heart strong, influence the blood pressure and eradicate the extra fluid.
• Oxygen therapy.
• Avoiding strenuous activities.
• There are some surgical treatments as well which depends on kind of anomaly.

Coronary Artery Anomaly is detected by imaging modalities and according to various sources their effects ranges from 0.21% to 5.79%. The index of suspicion of this disease is shown to be high in young patients and should be treated immediately. The incidence of coronary anomalies is generally reported to be about 1%. It is important to carry out a long term follow up in patients who have undergone the Coronary artery anomaly surgery in order to rule out any further complications.

References: