Left Main Coronary Artery Arising From the Right Coronary Sinus Presenting as Acute Coronary Syndrome: A Rare Anomaly Managed Conservatively

Coronary artery anomalies are extremely rare with a prevalence of 2.33% and they are extremely difficult to diagnose with the help of conventional tests. Once diagnosed, the associated life-threatening risks and complications that arise during surgical management are the dangers related to such anomalies. We present a case of a 45-year-old female, with chief complaints of chest pain radiating to back and left shoulder associated with palpitations for 7 days, a known case of systemic hypertension and diabetes mellitus type 2 for 7 years on regular medications. A series of investigations were conducted that included an electrocardiogram showing ischemic changes, a two-dimensional echocardiography that revealed globally dysfunctional left ventricle and an ejection fraction of 45%, and finally, a diagnostic coronary angiography leading to the diagnosis of the an abnormal origin of the left main coronary artery through the right coronary sinus associated with 80% stenotic lesion in the "left anterior descending artery " and 90% stenotic lesion in the "left circumflex artery ". The report concludes that anomalies arising from coronary arteries are extremely infrequent and difficult to diagnose. In addition, they can present with life-threatening complications during surgical management.