Chest Pain due to Atherosclerotic Coronary Artery Disease in a Patient with Single Coronary Artery

Coronary artery anomalies are rare, and single coronary arteries are even rarer occurring 0.024%- 0.066% in the general population. They range in presentation from being asymptomatic to severe chest pain and even sudden death. There are numerous variations of Coronary artery anomalies, some benign and others potentially lethal. Benign variations include separate origination of the left anterior descending and left circumflex arteries from the left sinus of Valsalva, an ectopic origin of right coronary artery or left main trunk from the posterior sinus of Valsalva, and intercoronary communication. Potentially serious anomalies, which constitute 19% of anomalies, include an ectopic coronary origin form the pulmonary artery, an ectopic origin of the left coronary artery from the right sinus of Valsalva, and a Single Coronary Artery. We present a case of a 65-year-old lady who presented with chest pain and was diagnosed, incidentally on cardiac catheterization as having a single coronary artery supplying the entire heart. The cardiac catheterization showed the patient did not have a right coronary artery. Rather, left circumflex branch of left main coronary artery continued as right coronary artery to supply the right side of the heart. Thecatheterization also showed a 90% stenosis to the proximal diagonal 1 branch of the Left anterior descending; a percutaneous coronary intervention was performed to the diagonal 1 lesion. The patient was chest pain free upon discharge and instructed to follow up in cardiology clinic.