Document Type : Case Report


1 Associate Professor, Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh, India

2 Department of Cardiology, LPS Institute of Cardiology, Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur, Uttar Pradesh, India


BACKGROUND: Hypertrophic cardiomyopathy (HCM) and anomalous coronary artery arising from the opposite sinus are independently associated with increased risk of sudden cardiac death (SCD). Their coexistence in a single patient further complicates the issue by affecting management strategy and increasing the risk of sudden death.
CASE REPORT: A 21-year-old woman with hypertrophic obstructive cardiomyopathy (HOCM) having strong family history of SCD presented with exertional fatigue and palpitation. Cardiac catheterization and computed tomography (CT) coronary angiography revealed single left coronary artery where left main trunk was trifurcating into left anterior descending (LAD), left circumflex (LCX), and right coronary artery (RCA). The course of RCA was retro-aortic. There were no appreciable septal arteries to be ablated by alcohol injection. The patient was managed with implantable cardioverter-defibrillator (ICD) and metoprolol.
CONCLUSION: Single coronary artery (SCA) and HOCM are of great clinical significance as both of these conditions are independently associated with SCD. Medical management in form of beta blocker and ICD is an acceptable treatment strategy in appropriately selected symptomatic obstructive HCM. To the best of our knowledge, this is the first ever case report of RCA following a retro-aortic course arising from left main in a patient with obstructive HCM.


  1. Alqarqaz M, Zaidan M, Al-Mallah MH. Hypertrophic cardiomyopathy and anomalous left coronary artery: a rare combination. J Cardiovasc Med (Hagerstown) 2011; 12(12): 915-8.
  2. Yamanaka O, Hobbs RE. Coronary artery anomalies in 126,595 patients undergoing coronary arteriography. Cathet Cardiovasc Diagn 1990; 21(1): 28-40.
  3. Harjai KJ, Cheirif J, Murgo JP. Ischemia and atherosclerotic coronary artery disease in patients with hypertrophic cardiomyopathy: A review of incidence, pathophysiological mechanisms, clinical implications and management strategies. Coron Artery Dis 1996; 7(3): 183-7.
  4. Angelini P, Velasco JA, Flamm S. Coronary anomalies: Incidence, pathophysiology, and clinical relevance. Circulation 2002; 105(20): 2449-54.
  5. Taylor AJ, Rogan KM, Virmani R. Sudden cardiac death associated with isolated congenital coronary artery anomalies. J Am Coll Cardiol 1992; 20(3): 640-7.
  6. 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(6): 1493-501.
  7. Efthimiadis GK, Theofilogiannakos EK, Gossios TD, Paraskevaidis S, Vassilikos VP, Styliadis IH. Hypertrophic cardiomyopathy associated with an anomalous origin of right coronary artery. Case report and review of the literature. Herz 2013; 38(4): 427-30.
  8. Liddy S, Roy AK, McCreery C. Double trouble: Hypertrophic cardiomyopathy coexistent with malignant anomalous right coronary artery. BMJ Case Rep 2014; 2014: