Typical chest pain revealing a hypoplastic left circumflex coronary artery in a young adult with sickle cell disease: a case report

Hypoplastic coronary artery disease (HCAD) is defined as underdevelopment or smallness of one or both coronary arteries or their main branches. Patients with this condition are typically asymptomatic, and the first clinical presentation may be sudden cardiac death (SCD) or syncope, so early detection of these anomalies is critical to avoid SCD. The etiology of hypoplastic left circumflex coronary artery (LCX) is thought to be due to a delay in myocardial angiogenesis during heart development, or myocardial angiogenesis occurs through specific morphogenetic processes at different developmental time points. We report a 32 year‑old Palestinian male smoker with a significant history of sickle cell disease. He was complaining of chest pain that started 5 days ago, not radiating, associated with shortness of breath. After evaluation, he had a normal physical examination, a normal ECG, and CCTA was ordered, showing an isolated small hypoplastic left circumflex artery. Chest pain is a rare presentation of isolated hypoplastic LCX; after excluding common causes, clinicians should consider coronary anomalies.