PMC5534290_01
Admission electrocardiogram.
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His first electrocardiogram (Figure 1) showed ectopic atrial rhythm, inferior inactive zone, and ST elevation in precordial leads V1-V3 (there were no previous electrocardiogram tracings available for comparison).
Coronary angiography. (a) Normal left coronary artery; (b) proximal occlusion of anomalous right coronary artery (black arrow) originating in the left Valsalva sinus.
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Left main and circumflex were free of significant obstruction and left anterior descending artery had a moderate systolic dynamic compression caused by intramyocardial bridging in the mid segment with normal TIMI flow (Figure 2).
Post-PCI angiogram. RCA seen in both LAO (a) and RAO (b) views. Good poststenting result in proximal RCA (TIMI 3) but slow flow (TIMI 2) in RV marginal branches. RCA: right coronary artery; LAO: left anterior oblique; RAO: right anterior oblique; TIMI: thrombolysis in myocardial infarction; RV: right ventricular.
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Right coronary artery had its anomalous origin close to the left coronary sinus and was occluded in the proximal segment (Figure 3).
Predischarge electrocardiogram.
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The patient had in-hospital course free of complications and predischarge evaluation revealed normal left and right ventricular function (ejection fraction 59%) and complete resolution of precordial electrocardiogram abnormalities and return to normal sinus rhythm (Figure 4).