Ischemia in single right coronary artery

This is the case of a 77-year-old woman with hypertension, dyslipidemia, and stage V chronic kidney disease. While on hemodialysis she experiences precordial pain due to paroxysmal atrial fibrillation with rapid ventricular response. The electrocardiogram shows widespread ST-segment depression. The blood tests confirm the presence of slightly elevated ultrasensitive troponin I levels later showing an ascending and descending curve suggestive of acute coronary syndrome. A coronary angiography is indicated after these findings. The coronary angiography shows a single right coronary artery (figure 1) running through the atrioventricular sulcus and generating branches with perfusion to all myocardial territories of the left and right ventricles (figure 2 and video of the supplementary data). Figure 1. Figure 2. The prevalence of single right coronary artery is between 0.024% and 0.066%; the single right coronary artery is, actually, one of the rarest variants. In these patients, flow runs through a system with a large sequence of serial resistances. Based on these findings, we could argue that the perfusion of medioapical segments would be in a situation of «relative» ischemia compared to the rest. This would exacerbate in situations of greater myocardial demand as in tachyarrhythmias. Although cases of...