Anomalous aortic origin of coronary arteries: Is it time to revise preparticipation screening guidelines?

ABSTRACT Anomalous aortic origin of the coronary arteries has gained significant attention in recent years, being suggested as the second most common cause of sudden death among young athletes and schoolchildren. Most patients remain asymptomatic until intense physical activity triggers ischemia, leading to myocardial hypoperfusion and potentially resulting in syncope, chest pain, or sudden cardiac death. Due to its often-asymptomatic nature, this anomaly can be missed by a standard 12-lead electrocardiogram (ECG) at rest. Therefore, incorporating additional diagnostic tools, such as echocardiography or stress ECG, into preparticipation screening guidelines may improve detection and prevent tragic outcomes in at-risk individuals.