Coronary Artery Occlusion

coronary artery occlusion

This 70 year old lady presented with chest pain. Cardiac enzymes were elevated and ECG showed changes of acute inferior transmural myocardial infarction. CT chest was performed to exclude associated aortic dissection because of the pattern of chest pain. CT showed no evidence of aortic dissection but shows occlusion of the right coronary artery, most likely by atheroma and thrombus. Coronary angiography confirmed 100% proximal right coronary artery occlusion which was successfully treated with angioplasty.

The right coronary artery is dominant in 85% and gives rise to the posterior descending artery which supplies the inferior portion of the left ventricle. The right coronary artery also supplies the atrioventricular node and right ventricle. Hence right coronary artery occlusion can give rise to inferior left ventricular infarct, right ventricular infarct and bradycardia

References:
1. Dahnert W. Radiology Review Manual. 5th edition. Lippincott Williams & Wilkins 2003.
2. Brady et al. Pocket Radiologist Cardiac Top 100 Diagnoses. Amirsys 2003.

Credit: Dr Bernard Ng