Acute Inferior Myocardial Infarction with Anomalous Origin of the Right Coronary Artery, Myocardial Bridging and Fibro‐Lipid Plaque

We describe a 35-year-old male patient who had acute inferior myocardial infarction based on clinical signs and electrocardiographic abnormalities after experiencing sudden chest pain for 2 h. An abnormal origin of the right coronary artery (RCA) from the left coronary sinus was discovered by emergency coronary angiography, along with mild stenosis in the mid-RCA segment that persisted even after intracoronary nitroglycerin was administered. The mid-RCA lesion was identified by intravascular ultrasonography (IVUS) as a 48% stenotic fibro-lipid plaque with a lipid core and thin fibrous top. A minimum luminal diameter of 2.14 mm was found at the deformed RCA ostium with concomitant myocardial bridging. The patient experienced total symptom alleviation and an uneventful recovery after receiving dual antiplatelet therapy, intense lipid-lowering treatment, diltiazem for myocardial bridging, and stringent risk factor control. For long-term risk reduction, a multidisciplinary evaluation is planned for surgical of the coronary abnormality. In addition to highlighting the significance of tailored management approaches for congenital coronary anomalies combined with acquired vulnerable plaques, this case underscores the crucial role of multimodality imaging, particularly IVUS, in accurate etiological diagnosis and treatment decision-making for young patients with acute myocardial infarction (AMI) caused by complex coronary lesions.