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The electrocardiogram as an adjunct in diagnosing congenital coronary arterial anomalies

Published online by Cambridge University Press:  01 December 2010

Mitchell Cohen  and
Stuart Berger
Mitchell Cohen*
Affiliation:
Department of Pediatric Cardiology, Phoenix Children’s Hospital and Arizona Pediatric Cardiology Consultants/Pediatrix Cardiology, Phoenix, Arizona, United States of America
Stuart Berger
Affiliation:
Department of Pediatric Cardiology Herma Heart Center, Children’s Hospital of Milwaukee, Milwaukee, Wisconsin, United States of America
*
Correspondence to: M. Cohen, MD FACC, Section Chief, Pediatric Cardiology, Phoenix Children’s Hospital, Arizona Pediatric Cardiology/Pediatrix, Clinical Associate Professor of Pediatrics, University of Arizona School of Medicine, Phoenix, Arizona, United States of America. Tel: 602-253-6000; Fax: 602-256-2878; E-mail: Mitchell_Cohen@Pediatrix.com
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Abstract

Congenital coronary arterial abnormalities as isolated lesions are exceedingly rare. The electrocardiogram, while a reasonable adjunct in the diagnosis of coronary arterial abnormalities, should not supplant a good history and physical examination. Careful attention must be devoted to any signs or symptoms of ischaemic pain in the chest or syncope, which must not be overlooked. Exertional pain in the chest and exertional syncope should prompt an extensive evaluation by both the echocardiographer and the electrophysiologist. Clearance for participation in sports should be curtailed until a complete evaluation has ruled out the presence of any of the following disorders: a channelopathic mutation, a cardiomyopathy, or a congenital coronary arterial anomaly. Major abnormalities in the coronary arteries may present in the first few months of life or remain dormant until the exertional demands of adolescence unmask symptoms of myocardial ischaemia. Congenital coronary arterial anomalies may be analysed in the following major diagnostic groups: anomalous origin of the left coronary artery from the pulmonary artery, anomalous aortic origin of a coronary artery from the wrong aortic sinus of Valsalva, atresia of the left main coronary artery, myocardial bridges, and coronary arterial fistulas. The advent of state-of-the-art modalities of imaging seems, at times, to have supplanted the electrocardiogram in making the diagnosis of potentially serious coronary artery abnormalities, especially in asymptomatic patients. However, as is also the case for a detailed history and physical examination, the electrocardiogram provides a potentially insightful look at the coronary arteries. Furthermore, the past decade has witnessed an increase in the use of the electrocardiogram as a screening tool in the assessment of the risk of sudden cardiac death in athletes in high school.

Keywords

Congenital cardiac diseasepaediatric cardiac diseaseanomalous aortic origin of the coronary arteryanomalous origin of the coronary artery from the pulmonary arterycoronary arterial fistula
Type
Original Article
Information
Cardiology in the Young , Volume 20 , Issue S3: Rare and Challenging Congenital Cardiac Lesions: an Interdisciplinary Approach , December 2010 , pp. 59 - 67
Copyright
Copyright © Cambridge University Press 2010

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References

1.Corrado, D, Basso, C, Pavei, A, Michieli, P, Schiavon, M, Thiene, G. Trends in sudden cardiovascular death in young competitive athletes after implementation of a pre-participation screening program. JAMA 2006; 296: 1593–1601.Google Scholar
2.Keith, JD. The anomalous origin of the left coronary artery from the pulmonary artery. Br Heart J 1959; 21: 149–161.CrossRefGoogle ScholarPubMed
3.De Wolf, D, Vercruysse, T, Suy, B, Blom, N, Matthys, D, Ottenkamp, J. Major coronary anomalies in childhood. Eur J Pediatr 2002; 161: 637–642.CrossRefGoogle ScholarPubMed
4.Brekke, D, DeGroff, C, Schaffer, M. Changing electrocardiographic patterns during medical treatment in a patient with anomalous left coronary originating from the pulmonary artery. Circulation 2001; 103: e85.CrossRefGoogle Scholar
5.Chang, RKR, Allada, V. Electrocardiographic and echocardiographic features that distinguish anomalous origin of the left coronary artery from the pulmonary artery from idiopathic dilated cardiomyopathy. Pediatr Cardiol 2001; 22: 3–10.CrossRefGoogle ScholarPubMed
6.Berger, S. Automated external defibrillators utility, rational, and controversies. PACE 2009; 32: S75–S79.CrossRefGoogle ScholarPubMed
7.Corrado, D, Basso, C, Schiavon, M, Pelliccia, A, Thiene, G. Pre-participation screening of young competitive athletes for prevention of sudden cardiac death. J Am Coll Cardiol 2008; 52: 1981–1989.CrossRefGoogle ScholarPubMed
8.Corrado, D, Basso, C, Schiavon, M, Thiene, G. Screening for hypertrophic cardiomyopathy in young athletes. N Engl J Med 1998; 339: 364–369.CrossRefGoogle ScholarPubMed
9.Maron, BJ, Gohman, TE, Aeppli, D. Prevalence of sudden death during competitive sports activity in Minnesota high school athletes. J Am Coll Cardiol 1998; 32: 1881–1884.CrossRefGoogle ScholarPubMed
10.Maron, BJ, Epstein, SE, Roberts, WC. Causes of sudden death in competitive athletes. J Am Coll Cardiol 1986; 7: 204–214.CrossRefGoogle ScholarPubMed
11.Thiene, G, Nava, A, Corrado, D, et al. Right ventricular cardiomyopathy and sudden death in young people. N Engl J Med 1988; 318: 129–133.CrossRefGoogle ScholarPubMed
12.Burke, AP, Farb, A, Virmani, R, et al. Sports-related and non-sports related sudden cardiac death in young adults. Am Heart J 1991; 121: 568–575.Google Scholar
13.Maron, BJ, Shirani, J, Poliac, LC, et al. Sudden death in young completive athletes: clinical, demographic and pathological profiles. JAMA 1996; 276: 199–204.CrossRefGoogle Scholar
14.Maron, BJ, Doerer, JJ, Haas, TS, Tierney, DM, Mueller, FO. Sudden deaths in young competitive athletes. Circulation 2009; 119: 1085–1092.CrossRefGoogle ScholarPubMed
15.Click, RL, Vleitrstra, RE, Kosinski, AS, et al. Anomalous coronary arteries: location, degree of atherosclerosis and effect on survival- a report from the coronary artery surgery study. J Am Coll Cardiol 1989; 13: 531–537.CrossRefGoogle ScholarPubMed
16.Davis, JA, Cecchin, F, Jones, TK, et al. Major coronary artery anomalies in a pediatric population: incidence and clinical importance. J Am Coll Cardiol 2001; 37: 593–597.CrossRefGoogle Scholar
17.Yamanaka, O, Hobbs, RE. Coronary artery anomalies in 126,595 patients undergoing coronary artery angiography. Cathet Cardiovasc Diagn 1990; 21: 28–40.CrossRefGoogle Scholar
18.Eckart, RE, Scoville, SL, Campbell, CL, et al. Sudden death in young adults: a 25-year review of autopsies in military recruits. Ann Intern Med 2004; 141: 829–834.CrossRefGoogle ScholarPubMed
19.Frescura, C, Basso, C, Thiene, G, et al. Anomalous origin of coronary arteries and risk of sudden death: a study based on an autopsy population of congenital heart disease. Hum Pathol 1998; 29: 689–695.CrossRefGoogle Scholar
20.Roberts, WC, Sigel, RJ, Zipes, DP. Origin of the right coronary artery from the left facing sinus of Valsalva and its functional consequences: analysis of 10 necropsy patients. Am J Cardiol 1982; 49: 863–868.CrossRefGoogle Scholar
21.Cheitlin, MD, De Castro, CM, Mc Allister, HA. Sudden death as a complication of anomalous left coronary origin from the anterior sinus of Valsalva, a not-so-minor congenital anomaly. Circulation 1974; 50: 780–787.CrossRefGoogle ScholarPubMed
22.Taylor, AJ, Rogan, KM, Virmani, R. Sudden death associated with isolated congenital coronary artery anomalies. J Am Coll Cardiol 1992; 20: 640–647.CrossRefGoogle ScholarPubMed
23.Virmani, R, Rogan, KM, Cheitlin, M. Congenital coronary artery anomalies: pathologic aspects. In: Virmani R, Forman MB (eds.). Non-atherosclerotic Ischemic Heart Disease. Raven Press, New York, 1989: 153–155.Google Scholar
24.Brothers, J, Carter, C, McBride, M, Spray, T, Paridon, S. Anomalous left coronary artery from the opposite sinus of Valsalva: evidence of intermittent ischemia. J Thorac Cardiovasc Surg 2009; 1: 1–3.Google Scholar
25.Basso, C, Frescura, C, Corrado, D, et al. Congenital heart disease and sudden cardiac death in the young. Hum Pathol 1995; 26: 1065–1072.CrossRefGoogle Scholar
26.Cheitlin, MD, De Castro, CM, McAllister, HA. Sudden death as a complication of anomalous coronary origin from the anterior sinus of Valsalva. Circulation 1974; 50: 780–787.Google Scholar
27.Kragel, AH, Roberts, WC. Anomalous origin of either the right or left main coronary artery from the aorta with subsequent coursing between the aorta and pulmonary trunk: analysis of the 32 necropsy cases. Am J Cardiol 1988; 62: 771–777.CrossRefGoogle ScholarPubMed
28.Liberthson, RR. Sudden death from cardiac causes in children and young adults. N Engl J Med 1996; 334: 1039–1044.Google Scholar
29.Maron, BJ, Thompson, PD, Ackerman, MJ, et al. Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes: 2007 update. Circulation 2007; 115: 1643–1655.CrossRefGoogle ScholarPubMed
30.Basso, C, Maron, BJ, Corrado, D, Thiene, G. Clinical profile of congenital coronary artery anomalies with origin from the wrong aortic sinus leading to sudden death in young competitive athletes. J Am Coll Cardiol 2000; 35: 1493–1501.Google Scholar
31.Corrado, D, Thiene, G, Coco, P, Frescura, C. Non-atherosclerotic coronary artery disease and sudden death in the young. Br Heart J 1992; 68: 601–607.Google Scholar
32.Phoon, CK, van Sohn, J, Moore, PA, et al. Aberrant left coronary artery arising from the right sinus of Valsalva with a right coronary arteriovenous malformation. Pediatr Cardiol 1997; 18: 385–388.CrossRefGoogle ScholarPubMed
33.Zeppilli, P, Della Russo, A, Santini, C, et al. In vivo detection of coronary artery anomalies in asymptomatic athletes by echocardiographic screening. Chest 1998; 114: 89–93.CrossRefGoogle ScholarPubMed
34.Brothers, JA, McBride, MG, Seliem, MA, et al. Evaluation of myocardial ischemia after surgical repair of anomalous aortic origin of a coronary artery in a series of pediatric patients. J Am Coll Cardiol 2007; 50: 2078–2082.Google Scholar
35.Musiani, A, Cerniagliaro, C, Sansa, M, Maseli, D, DeGasparis, C. Left main coronary artery atresia: literature review and therapeutical considerations. Eur J Cardiothorac Surg 1997; 11: 505–514.CrossRefGoogle ScholarPubMed
36.Bezerra, AJC, Pratesd, JC, Didio, LJA. Incidence and clinical significance of bridges of myocardium over the coronary arteries and their branches. Surg Radiol Anat 1987; 9: 273–280.Google Scholar
37.Bashour, TT, Espinosa, E, Blumenthal, J, et al. Myocardial infarction caused by coronary artery myocardial bridge. Am Heart J 1997; 133: 473–477.CrossRefGoogle ScholarPubMed
38.Bestetti, RB, Finzi, LA, Amarl, FT, Secches, AL, Oliveira, JS. Myocardial bridging of coronary arteries associated with impending myocardial infarction. Clin Cardiol 1987; 10: 129–131.CrossRefGoogle Scholar
39.Agirbasli, M, Martin, GS, Stout, JB, et al. Myocardial bridge as a cause of thrombus formation and myocardial infarction in a young athlete. Clin Cardiol 1997; 20: 1032–1036.CrossRefGoogle Scholar
40.Ortega-Carnicer, J, Fernández-Medina, V. Impending acute myocardial infarction during severe exercise associated with a myocardial bridge. J Electrocardiol 1999; 32: 285–288.Google Scholar
41.Bauer, M, Bauer, U, Alexi-Meskishvilli, V, et al. Congenital coronary fistulas: the most frequent congenital coronary anomaly. Z Kardiol 2001; 90: 535–541.CrossRefGoogle ScholarPubMed
42.Holzer, R, Johnson, R, Ciotti, G, Poszzi, M, Kitchiner, D. Review of an institutional experience of coronary arterial fistulas in childhood set in context of review of the literature. Cardiol Young 2004; 14: 380–385.CrossRefGoogle ScholarPubMed