Coronary artery anomalies (CAA) may be associated with sudden death. The risk of sudden death depends on the anomaly.

Coronary Artery Anomaly

Risk of Sudden Death

origin from the pulmonary trunk

very high

origin of LCA from opposite right sinus of Valsalva


ostial stenosis or atresia


origin of RCA from LCA


origin of LCX from RCA with retroaortic course


high take off (high ostium), with variable intramural aortic course


myocardial bridge (course through myocardial wall)


termination of coronary artery branch into a cardiac chamber or the aorta (fistula)

uncertain; risk of aneurysmal dilation and rupture



• LCX = left circumflex coronary artery; LCA = left coronary artery; RCA = right coronary artery


For anomalies with uncertain risk, the examination should look for features that may affect risk, such as narrowing at the ostium or external compression.


An athlete with a coronary artery anomaly should have (1) imaging studies to identify high risk features and (2) exercise stress testing for ischemia.

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