200 Rev Esp Cardiol 2002;55(2):200-2 164 The case of a 71-year-old male patient, with symptoms of dizzines and atypical chest pain and a positive isotopic exercise stress test, is reported. Coronary angiography demostrated an anomalous origin of the left circumflex coronary artery from right coronary ostium but no obstruc- tive atherosclerotic coronary lesions. The posible relation between the congenital coronary anomaly and the clinical manifestations of the patient is discussed. Key words: Catheterization. Congenital heart defects. Ischemia. Scintigraphy. bilitation for left cervicobrachyalgia due to C6-C7cer- vicoarthrosis. Occasionally and with no relation to ef- fort, he referred dizziness without loss of conscious- ness and sweating followed by «chest discomfort.» Sublingual nitroglycerin resolved his dizziness and «discomfort.» He was admitted to our hospital with normal electrocardiograms and serial cardiac enzymes. Conventional stress testing following the Bruce proto- col had to be interrupted for dizziness and emotional lability when 84% of theoretical maximum exercise heart rate (MEHR) was reached with no electrical changes being observed. A 24-h Holter study was nor- mal. He was released with anxiolytic medication to complete studies on an outpatient basis. In later follow-up visits he continued to have occa- sional dizziness and «chest discomfort» without losing consciousness «because he would lay down on the ground.» Several Holter studies were requested, but continued to be normal. A tilt-test was negative. Given his reiterated symp- toms a radionuclide myocardial perfusion test was made. After a conventional exercise stress test, accor- ding to the Bruce protocol, images at rest were obtai- ned 3 h after intravenous administration of the radio- drug (Tc; 8 and 20-mCi doses). The conventional stress test was discontinued when dizziness appeared in 5 minutes, when the patient had reached 86% of B RIEF R EPORTS Myocardial ischemia caused by an anomalous circumflex coronary artery Roberto Barriales Villa, Beatriz Díaz Molina, Juan Carlos Arias Castaño, Rodrigo Medina Alba, Raúl Casariego Rosón and Manuel Penas Lado Servicio de Cardiología. Complexo Hospitalario de Pontevedra. Correspondence: Dr. R. Barriales Villa. Servicio de Cardiología. Complexo Hospitalario de Pontevedra. Mourente-Montecelo. 36071 Pontevedra. Spain e-mail: rbarrialesv@inicia.es Received 25 April 2001. Accepted for publication 10 July 2001. Isquemia miocárdica causada por una arteria circunfleja anómala Presentamos el caso de un varón de 71 años con ma- reos y molestias torácicas atípicas, que presentó un test de esfuerzo con isótopos positivo. Se realizó una corona- riografía que puso de manifiesto una arteria circunfleja que se originaba en el ostium coronario derecho y que no presentaba lesiones ateroscleróticas asociadas. Se dis- cute la posible relación entre la clínica del paciente y la circunfleja anómala. Palabras clave: Cateterismo cardíaco. Cardiopatías congénitas. Isquemia. Gammagrafía. INTRODUCTION The increasingly extended use of diagnostic corona- riography is discovering numerous congenital anoma- lies of the coronary arteries. At first they were consi- dered simple coronariographic findings and there was a tendency to characterize them as benign. However, this attitude was undermined by reports of cases of sudden death, AMI, angina, and syncope associated with their presence. We now think that a new attitude is needed and, although not all coronary anomalies should be considered malignant, we must begin to consider them «potentially malignant.» CLINICAL CASE The patient was a 71 year-old male watchmaker with no family history of ischemic heart disease or known coronary risk factors. He was undergoing reha- Document downloaded from https://www.revespcardiol.org/?ref=2053136631, day 02/09/2022. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. Document downloaded from https://www.revespcardiol.org/?ref=2053136631, day 02/09/2022. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited.