Surreal illustration of a heart with an anomalous coronary artery.

Rare Heart Anomaly Mimics Heart Attack: A Diagnostic Journey

Jordan Keane in Health & Wellness July 2025 • 4 min read.

"Unveiling a hidden cause of myocardial infarction: A case of anomalous coronary origin and the critical role of advanced imaging."

Coronary artery anomalies, though infrequent (occurring in approximately 0.6% to 1.5% of coronary angiographies), can present significant diagnostic and clinical challenges. While many individuals with these anomalies remain asymptomatic, others may experience life-threatening conditions. Therefore, accurate identification and visualization of these anomalies are critical for effective patient management.

However, in some instances, standard coronary angiography (CAG) may not suffice to precisely pinpoint the origin and course of an anomalous vessel. This is where advanced imaging techniques come into play. This article delves into a fascinating case report that underscores the importance of a comprehensive diagnostic approach.

We explore the case of a 54-year-old man presenting with an acute inferior myocardial infarction. The investigation led to the unexpected discovery of a rare coronary anomaly—the left circumflex coronary artery (LCX) originating from the first diagonal branch. This case highlights the diagnostic complexities and the value of multi-detector computed tomography (MD-CT) in clarifying such anatomical variations.

Decoding the Anomaly: How a Misplaced Artery Mimicked a Heart Attack

Surreal illustration of a heart with an anomalous coronary artery.

A 54-year-old male with a history of hypertension and a 30 pack-year smoking habit was admitted to the hospital due to chest pain. His initial electrocardiogram (ECG) revealed ST-segment elevation in leads II, III, and aVF, indicative of an acute inferior myocardial infarction.

Coronary angiography (CAG) was immediately performed. Surprisingly, the right coronary artery (RCA) showed no significant blockages. However, the left circumflex artery (LCX) was not visualized through conventional methods, raising suspicion of a complete blockage at its origin.

The diagnostic team encountered several challenges:

Initial suspicion of LCX ostial occlusion: Attempts to pass a guidewire into the LCX were unsuccessful, suggesting a potential blockage at its origin.
Discovery of an unusual vessel: A small artery originating from the first diagonal branch (D1) was identified, exhibiting thrombolysis in myocardial infarction (TIMI) flow grade 1, indicating severely restricted blood flow.
Intervention and further investigation: Balloon angioplasty was performed on the anomalous vessel and the D1. Subsequent angiograms revealed that the course of this vessel resembled that of a typical LCX.

To definitively map the precise anatomical course of the coronary arteries, 64-slice multi-detector computed tomography (MD-CT) was performed. This advanced imaging technique confirmed the anomalous origin of the LCX, clearly showing it arising from the D1 and coursing along the left atrioventricular groove.

The Takeaway: Why Recognizing Rare Anomalies Matters

This case underscores the critical importance of considering coronary artery anomalies in patients presenting with acute myocardial infarction, especially when standard angiographic findings are inconclusive. Advanced imaging techniques like MD-CT play a vital role in clarifying complex anatomical variations, ensuring accurate diagnosis and appropriate management. Early detection and precise delineation of the proximal course of anomalous coronary arteries are crucial for optimal patient outcomes.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.4070/kcj.2011.41.10.612, Alternate LINK

Title: Anomalous Origin Of The Left Circumflex Coronary Artery From The First Diagonal Branch Presented As Acute Myocardial Infarction

Subject: Cardiology and Cardiovascular Medicine

Journal: Korean Circulation Journal

Publisher: The Korean Society of Cardiology

Authors: Jung Hyun Kim, Geun Jin Ha, Myung Jun Seong, Jin Wook Jung, So Yeon Kim, Sung Hee Moon, Young Soo Lee

Published: 2011-01-01

Everything You Need To Know

How common are coronary artery anomalies, and why is it important to identify them?

Coronary artery anomalies occur in a small percentage of coronary angiographies, specifically between 0.6% and 1.5%. While many individuals with these anomalies may not experience any symptoms, others can face life-threatening conditions. This variability underscores the importance of accurate identification and visualization of these anomalies to ensure effective patient management and prevent adverse outcomes.

Why can't standard coronary angiography always detect coronary artery anomalies effectively?

Standard coronary angiography (CAG) is the conventional method for visualizing coronary arteries. However, in cases of coronary artery anomalies, CAG may not always be sufficient to precisely determine the origin and course of an anomalous vessel. This limitation highlights the need for advanced imaging techniques like multi-detector computed tomography (MD-CT) to provide a more detailed and accurate assessment of the coronary anatomy.

What initial findings suggested a heart attack in the presented case?

In the case described, the patient's initial electrocardiogram (ECG) indicated an acute inferior myocardial infarction, characterized by ST-segment elevation in leads II, III, and aVF. This finding prompted an immediate coronary angiography (CAG) to assess the coronary arteries and identify any potential blockages or abnormalities contributing to the heart attack symptoms.

What role did multi-detector computed tomography (MD-CT) play in diagnosing the coronary anomaly?

Multi-detector computed tomography (MD-CT) played a crucial role in definitively mapping the precise anatomical course of the coronary arteries in this specific scenario. MD-CT is an advanced imaging technique that confirmed the anomalous origin of the left circumflex coronary artery (LCX), demonstrating that it arose from the first diagonal branch (D1) and coursed along the left atrioventricular groove. This detailed visualization enabled accurate diagnosis and appropriate management.

What is the significance of recognizing rare coronary anomalies, and how does it affect patient management?

This case underscores the importance of considering coronary artery anomalies in patients presenting with acute myocardial infarction, especially when standard angiographic findings are inconclusive. Early detection and precise delineation of the proximal course of anomalous coronary arteries are crucial for optimal patient outcomes. Advanced imaging techniques like multi-detector computed tomography (MD-CT) play a vital role in clarifying complex anatomical variations, ensuring accurate diagnosis and appropriate management. Without these advanced diagnostic capabilities, such anomalies could be missed, potentially leading to inappropriate treatment strategies and adverse patient outcomes. Recognizing these rare anomalies and utilizing appropriate imaging modalities can significantly improve diagnostic accuracy and patient care in cases of suspected myocardial infarction.