Case report.
A 35-year-old male labourer was admitted following a one-month history of chest pain, including two weeks of dizziness and recurrent syncopal attacks. History taking demonstrated an extensive past medical history of chest pain since childhood and a positive family history of sudden death and sickle cell disease. Physical examination showed no remarkable findings, which was followed by a full blood count, serum troponin, urea & electrolytes - all within normal range. A 24-hour electrocardiogram (ECG) and echocardiogram were then performed, respectively portraying a normal sinus rhythm and normal cardiac structure with good ventricular function. A coronary angiogram was then performed using the Judkin’s catheterisation technique, which revealed an ectopic origin of the right coronary artery from the LSV. Following this diagnosis, the patient was referred to surgery for a coronary artery bypass graft (CABG), in which the right coronary artery was found to originate between the aorta and pulmonary trunk. Post-operative complications included moderate anaemia (Hb: 9.3g/dL) and cellulitis, treated with 4 units of blood and benzylpenicillin respectively. The patient was discharged on analgesia (Paracetamol 1g PO QDS) and antibiotics (Amoxicillin/Clavulanic Acid 1g BD for 7 days). Following up 7 days post-operatively, no further episodes of chest pain or syncope were reported by the patient.