Overview
Anomalous Coronary Artery (ACA) is a rare congenital condition where one or more of the coronary arteries arise from an abnormal location or follow an unusual path. While some anomalies are benign and asymptomatic, others can increase the risk of sudden cardiac arrest, especially in young athletes. Timely diagnosis and proper treatment are critical to prevent complications.
What is Anomalous Coronary Artery?
Anomalous Coronary Artery refers to a group of congenital abnormalities in the origin, course, or structure of the coronary arteries. These arteries supply oxygen-rich blood to the heart muscle. When they develop abnormally, blood flow may be compromised, especially during physical exertion, increasing the risk of chest pain, fainting, arrhythmias, or even sudden death.
The most concerning type is anomalous origin of a coronary artery from the opposite sinus (ACAOS), especially when the artery passes between the aorta and pulmonary artery.
Symptoms
- Chest pain (especially during exercise)
- Shortness of breath
- Palpitations
- Fainting or dizziness
- Sudden cardiac arrest (particularly in young people or athletes)
- In many cases, there are no symptoms, and it is discovered incidentally during imaging or autopsy
Causes
The condition is congenital, meaning it is present at birth and results from abnormal development of the coronary arteries during fetal growth. The exact cause is unknown, but it may involve:
- Genetic mutations
- Abnormal vascular remodeling
- Structural heart abnormalities
Risk Factors
- Family history of congenital heart defects
- Congenital heart disease (e.g., transposition of the great arteries, tetralogy of Fallot)
- Male gender – Higher incidence in males
- Athletic activity – Strenuous exertion increases risk of complications in those with undiagnosed ACA
Complications
- Myocardial ischemia (reduced blood flow to the heart)
- Arrhythmias (irregular heartbeats)
- Sudden cardiac arrest
- Heart failure
- Exercise-induced syncope or collapse
Prevention
ACA cannot be prevented as it is a congenital condition. However, early detection is crucial for those at risk:
- Routine screening for athletes with family history or unexplained symptoms
- Genetic counseling if a congenital heart defect runs in the family
- Avoidance of intense physical activity until the condition is assessed
Treatment Options in Korea
South Korea offers advanced cardiovascular diagnostics and surgical techniques to manage Anomalous Coronary Artery effectively.
Diagnosis:
- Echocardiography – Initial assessment of coronary artery structure
- CT Coronary Angiography – High-resolution imaging to define artery origin and course
- Cardiac MRI – To evaluate blood flow and identify myocardial ischemia
- Exercise Stress Testing – Assesses symptoms during exertion
- Coronary Angiography – Invasive but detailed imaging of coronary vessels
Treatment:
- Observation:
- For asymptomatic and low-risk anomalies
- Regular follow-up and imaging
- Medication:
- Beta-blockers to reduce heart strain
- Antiarrhythmic drugs if needed
- Surgical Intervention:
- Unroofing procedure – Commonly used if the anomalous artery runs between the great vessels
- Coronary reimplantation – Moving the artery to its proper location
- Bypass grafting – For severe cases or if reimplantation is not feasible
- Lifestyle Adjustments:
- Activity restrictions in high-risk patients
- Avoiding competitive sports until cleared by a cardiologist
