Anteriorly displaced right coronary artery in acute myocardial infarction: what should every cardiologist know

Anteriorly displaced right coronary artery (RCA) and anomalous origin RCAs occur in approximate to 1% and 0.1% of adult patients, respectively, and are the leading cause of incomplete coronary angiography and prolonged procedure times. We present a case in which anteriorly displaced RCA occlusion resulted in an acute inferior-posterior-right ventricular myocardial infarction complicated by complete atrioventricular block and hypotension. Failure to image the RCA resulted in considerable delay in reperfusion time with fibrinolysis. The authors discuss the most frequent anatomic locations of ectopic RCAs and suggest an algorithm to be employed when an ectopic RCA cannot be imaged with conventional diagnostic catheters. Contrary to popular belief, the search for an ectopic RCA has <90 degrees boundaries limited to the anterior third of the right sinus and anterior half of the left sinus. (C) 2011 Elsevier Inc. All rights reserved.