Electrocardiographic evidence of ischemia in a young male with anomalous origin of a coronary artery from the opposite sinus

Abstract Congenital coronary artery anomalies are a well-known cause of life-threatening syncope, but usually present with either cardiac arrest, or after resolution of the episode. We discuss a young man with exertional syncope, who upon evaluation in the field, had electrocardiographic evidence of severe but transient myocardial ischemia. This case provides rare insight into the pathophysiology of sudden cardiac death in patients with anomalous left coronary artery from the right aortic sinus.