An unusual case of chest pain and dyspnea on exertion

Congenital coronary artery anomalies occur in less than 1% of the general population with clinical consequences ranging from benign incidental findings to sudden cardiac death. More often than not this diagnosis is made on a postmortem examination but up to one third of the patients have symptoms such as exertional chest pain and dyspnea. Due to the correctable nature of this entity and the fact that anomalous origins of coronary arteries can be readily diagnosed by noninvasive cardiac imaging modalities, timely clinical suspicion based on symptoms is critical. We present a case of a 37 years old with exertional chest pain and dyspnea of several years duration who was found to have an anomalous origin of the left main coronary artery. A surgical correction was undertaken which resulted in resolution of his symptoms. Our case highlights the importance of keeping congenital coronary anomalies on the differential diagnosis for exertional chest pain and dyspnea in young individuals and following inconclusive noninvasive testing with more definitive diagnostic modalities.