Coronary Angiography in a Man With Angina, Right Bundle Branch Block, and Global Hypokinesis

A 32-year-old man underwent coronary angiography for evaluation of angina, dyspnea, a right bundle branch block (RBBB) on electrocardiography, and global hypokinesis on echocardiography. This video demonstrates opacification of the left coronary system with injection of contrast into the right coronary artery, consistent with an anomalous left coronary artery from the pulmonary artery (ALCAPA). ALCAPA is an exceedingly rare and potentially dangerous congenital coronary anomaly, with an estimated mean life expectancy of 35 years. Most patients are misdiagnosed for years with early-onset ischemic heart disease or myocarditis. Treatment is surgical correction. Click the Related Article link for a complete case description.