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What
are CAAs
The heart is supplied by two main arteries known simply as the left
coronary artery and the right coronary artery. Both arteries are
branches of the largest artery in the body which is the aorta. The aorta
in turn, arises from the left ventricle which is the main pumping
chamber of the heart. The left and right coronary arteries originate
from the left and right side respectively. Occasionally both arteries
originate from the right side of the aorta. This anomaly or oddity is
usually safe but in a few unfortunate cases can predispose to exercise
related death making coronary artery anomalies the second commonest
cause of death in young athletes (aged below 25 years) after the cardiomyopathies.
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Symptoms
Warning symptoms are sometimes present and include chest
pain or blackouts during physical exercise. The exact mechanism for the
cause of death is not entirely certain but it is thought that the
abnormal path taken by the artery causes it to "kink" or
"become squashed" between large vessels which are greatly
stretched with blood during exercise. The consequent loss of blood
supply to the heart can lead to the development of a heart attack or
electrical abnormality of the heart, producing sudden death.
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How
are CAAs Diagnosed
Screening for this coronary artery anomaly is possible using ultra
sound imaging of the heart, which is essentially the same equipment used
to diagnose cardiomyopathy. In thin athletic individuals the aorta and
the origins of both coronary arteries are easy to visualise. In those
individuals with symptoms in whom the coronary arteries cannot be seen
with the ultrasound, it is possible to perform a more detailed, yet
non-evasive (not requiring introduction of needles or small tubes into
the body) test known as a MRI (Magnetic Resonance Imaging) scan which is
good in visualising the coronary arteries. Coronary artery anomalies may
or may not run in families but the abnormality is always looked for when
screening any individual with a family history of premature sudden
death.
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Treatment
Treatment involves surgical plumbing of the left coronary artery to
the left side of the aorta. Many other coronary anomalies have been
described which are generally without the risk of exercise related
death.
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