Anomalous Right Coronary from Left Coronary Presenting as Anterior and Inferior Wall ST-elevation Myocardial Infarction

Coronary artery anomalies, particularly an anomalous right coronary artery (RCA) originating from the left anterior descending (LAD) artery, are rare and can present with unusual patterns of myocardial infarction. We discuss the case of a 49-year-old male with diabetes and hypertension who presented with chest pain, tachycardia, and hypotension. Electrocardiography showed ST-segment elevations in V1-V6, II, III, aVF, and V1R-V4R, indicating an anterior, inferior, and right ventricular ST-elevation myocardial infarction. Coronary angiography revealed a thrombotic occlusion of the proximal LAD artery and an anomalous RCA originating from the mid-LAD. This case highlights the challenges and poor prognosis associated with anomalous RCA from the LAD, emphasizing the challenges with fluid resuscitation and heart blocks.