Case Report| Volume 26, ISSUE 3, P178-180, September 2022

Double coronary anomaly: A case report


      We describe an extremely rare case of a 37-year-old female patient who presented with exertional angina and was diagnosed with a unique coronary anomaly with an anomalous right coronary artery with origin in the left anterior descending artery and a fistula between this anomalous coronary artery and the pulmonary artery.

      Learning objectives

      Most patients with coronary anomalies are asymptomatic but some may have angina caused by a coronary steal phenomenon, myocardial infarction, or even sudden death depending on the circuit and characteristics of the anomaly.
      The combination of multiple coronary anomalies is extremely rare.
      Despite being a rare diagnosis, coronary anomalies should always be considered as a cause of myocardial ischemia, especially in young patients with low probability for coronary obstructive disease.


      ARCA (anomalous origin of the right coronary artery), CTA (computed tomography angiography), Cx (circumflex artery), ECG (electrocardiogram), ICA (invasive coronary angiography), LAD (left anterior descending coronary artery), LM (left main coronary artery), PA (pulmonary artery), PDA (posterior descending artery), RCA (right coronary artery), RI (ramus intermedius)


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