A challenging case due to uncommon aberrancies.

A 71-year-old man was referred to a rapid access chest pain clinic by his general practitioner. He presented with a 6-month history of twice weekly central chest pain lasting 2-3 min with walking and exertion, relieved with rest or co-codamol tablets. After initial investigations and a positive myoview scan, he was listed for an elective coronary angiogram. Unfortunately, the procedure was abandoned due to unclear course of the guide wire and a possible aberrant aortic course. Further non-invasive tests were arranged to clarify the anatomy of the vessels. After getting a clear idea of the aberrancies, coronary angiogram was replanned, and the patient underwent successful angiography with angioplasty to one of the coronary arteries, without any complications.

Left main stem/LCA arising from right coronary sinus with an interarterial course.

A 67-year-old woman presented to the accident and emergency department with central chest pain for the past 4 months. She described the pain as severe, retrosternal, intermittent, indigestion/burning type, with radiations to the left arm. She had used antacids with no relief. Her medical history included hypertension, chronic obstructive pulmonary disease, pulmonary fibrosis, left mastectomy for breast cancer, hypercholesterolaemia and osteoarthritis. Her medications included anastrazole, indapamide, perindopril, aspirin, clopidogrel, atorvastatin, salbutamol and atrovent inhalers. She was a non-smoker and vegetarian. Two brothers each had a myocardial infarction when in their early 40s.