Chest Pain, Something is Not Right…Or Left.

A 46-year-old female was referred for evaluation of central chest pain unrelated to exertion. She was known to have diabetes mellitus, hypertension, and dyslipidaemia. Physical examination, routine blood investigations, electrocardiogram and chest radiograph were unremarkable. Stress myocardial perfusion imaging demonstrated normal perfusion of the left ventricle (LV) with no ischaemia detected. However, because of her cardiovascular risk factor profi le and recurrent episodes of chest pain, computed tomography coronary angiography (CTA) was performed to further evaluate the cause of chest pain (Figs. 1A, 1B and 1C). What is the most likely diagnosis? A. Left anterior descending artery occlusion with collateralisation from right coronary artery B. Anomalous origin of left anterior descending artery from the right cusp C. Single coronary artery from the right and absent left anterior descending artery D. Right coronary artery fi stula to the right ventricular outfl ow tract E. Myocardial bridging over the left anterior descending artery