Case report.
A 35-year-old male labourer was admitted following a one-month history
of chest pain, including two weeks of dizziness and recurrent syncopal
attacks. History taking demonstrated an extensive past medical history
of chest pain since childhood and a positive family history of sudden
death and sickle cell disease. Physical examination showed no remarkable
findings, which was followed by a full blood count, serum troponin, urea
& electrolytes - all within normal range. A 24-hour electrocardiogram
(ECG) and echocardiogram were then performed, respectively portraying a
normal sinus rhythm and normal cardiac structure with good ventricular
function. A coronary angiogram was then performed using the Judkin’s
catheterisation technique, which revealed an ectopic origin of the right
coronary artery from the LSV. Following this diagnosis, the patient was
referred to surgery for a coronary artery bypass graft (CABG), in which
the right coronary artery was found to originate between the aorta and
pulmonary trunk. Post-operative complications included moderate anaemia
(Hb: 9.3g/dL) and cellulitis, treated with 4 units of blood and
benzylpenicillin respectively. The patient was discharged on analgesia
(Paracetamol 1g PO QDS) and antibiotics (Amoxicillin/Clavulanic Acid 1g
BD for 7 days). Following up 7 days post-operatively, no further
episodes of chest pain or syncope were reported by the patient.