Case Presentation

A 34 year old female with no significant past medical history presented with intermittent left shoulder and chest pain. The pain was burning in nature over her left chest and radiated to her left arm. There were no alleviating or exacerbating factors. Initial electrocardiogram showed sinus bradycardia. Cardiac computed tomography angiography revealed anomalous origin of the right coronary artery, which arises from the left sinus of Valsalva (Figure 1) and then travels towards the right side between the pulmonary outflow tract and the aortic root, where it shows mild narrowing of about 50%, (Figure 2) for a length of approximately 1 cm. The woman performed 9 mets during her exercise stress nuclear test which demonstrated electrocardiographic evidence of ischemia with normal myocardial perfusion.