81. Case Report: Anomalous Left Coronary Artery from the Pulmonary Artery (ALCAPA) – Massachusetts General Hospital

CardioNerds(Amit Goyal& Karan Desai) join Massachusetts General Hospital cardiology fellows (Daniel Pipilas, Rachel Frank and Kemar Brown) on a luxurious sailboat for iced coffees and Modern Pastry delicacies! They discuss a rare case of Anomalous Left Coronary Artery from the Pulmonary Artery (ALCAPA). Program director, Dr. Doreen DeFaria Yeh provides the E-CPR and a message for applicants. Episode notes were developed by Johns Hopkins internal medicine residentEvelyn Songwith mentorship from University of Maryland cardiology fellowKaran Desai.

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Episode graphic by Dr. Carine Hamo

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Patient Summary

A women in her early 30s who’s a Jehovah’s witness presented with three days of intermittent chest pain. Past medical history included anxiety. Initial vitals and physical exam were unremarkable. Labswerenotable for an elevated troponin T of 360ng/Land a low TSH of 0.02mIU/Lwith an elevated free T4 of 5.1ng/dL. EKG demonstrated lateral and inferior ST depressions.TTE demonstrated a normal LVEF of 58% with a subtle anterolateral wall motion abnormality. Given her lack of conventional risk factors for CAD, resolution of her chest pain, anddowntrendingtroponin, coronary CTA was obtained next which did not show any CAD but demonstrated an anomalous left main coronary artery (LMCA) arising from the main pulmonary artery with evidence of left to right shunting from the left main into the PA and extensive coronary and bronchial collateralization. The anterior wall hypokinesis was also seen on CT, consistent with ischemia due to myocardial steal phenomenon.