Abnormal coronary artery courses are congenital anomalies that are usually detected incidentally. However, symptoms may begin to manifest in elderly patients when associated with age-related changes.
We present the case of an 87-year-old woman with hypertension and diabetes, well controlled with FRCV, came to the emergency room complaining of oppressive central chest pain accompanied by vegetative symptoms, the latter occurring after a family argument. Physical examination revealed only a small systolic murmur in the aortic focus, with the rest of the examination normal. During the hospitalisation period, the patient was monitored and presented paroxysms of atrial tachycardia, which also reproduced the clinic on chest pain.
Complementary tests showed that renal function was preserved with no ionic alterations, no mobilisation of myocardial damage markers, and normal haemoglobin levels. The ECG showed sinus tachycardia with no repolarisation alterations. A TTE was performed, showing preserved LVEF with no segmental alterations in contractility, as well as mild concentric hypertrophy. No other significant alterations were observed.
The patient had an intermediate pretest probability for ischaemic heart disease, so it was decided to perform non-invasive studies using coronary CT, which revealed a coronary anomaly with origin of the CX in the proximal CD with retroaortic course and also with a deep intramyocardial bridge 6 mm deep and 23 mm long in the middle third of the DA with “Milking” phenomenon, suffering significant reduction in its calibre during systole.
Coronary anomalies are congenital alterations that are mostly asymptomatic, but when associated with cardiac alterations typical of ageing, such as diastolic dysfunction, they can present symptoms. By treating diastolic perfusion and heart rate with beta-blockers, the symptoms were resolved. With this case, we want to highlight the importance of congenital abnormalities in geriatric patients, which should be included in the differential diagnosis of their pathology, emphasising the benign nature of these abnormalities.