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
high
ostial stenosis or atresia
high
origin of RCA from LCA
uncertain
origin of LCX from RCA with retroaortic course
uncertain
high take off (high ostium), with variable intramural aortic course
uncertain
myocardial bridge (course through myocardial wall)
uncertain
termination of coronary artery branch into a cardiac chamber or the aorta (fistula)
uncertain; risk of aneurysmal dilation and rupture
where:
• 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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