Heart HQ: Coronary Artery Anomalies • LITFL • Podcast

Heart HQ – Episode 8: Coronary Artery Anomalies and HRT

In this week’s podcast, Peter and Stuart chat about coronary artery anomalies.

There are many different types of coronary artery anomalies such as an inter-arterial course and a coronary artery fistula. Peter and Stuart discuss a couple of recent patients who had a fistula, and were diagnosed thanks to a CT Coronary Angiography (CTCA) scan.

And, prompted by a recent patient enquiry about the risk of cardiovascular disease when using hormone replacement therapy (HRT), they also discuss the 5 things to consider when it comes to HRT and CVD.

Show notes: Episode 8

Hormone Replacement Therapy (HRT)

For more on HRT and CVD risk, please refer to Figure 3 in the Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline.

Coronary Artery Anomalies

CTCA scans discussed

Coronary Artery Fistulae repair

Figure 3 from the Circulation article on Coronary Artery Anomalies

Conceptual diagram of possible paths — **Figure 3**. Conceptual diagram that shows most of the possible paths (1 through 5) by which the RCA, left anterior descending artery (LAD), and circumflex artery (Cx) can potentially connect with the opposite coronary cusps.
1, Retrocardiac;
2, retroaortic;
3, preaortic, or between the aorta and pulmonary artery;
4, intraseptal (supracristal);
5, prepulmonary (precardiac).
The aortic and pulmonary cusps are labeled according to their position in space: AL indicates antero-left; AR, antero-right; P, posterior; M, mitral valve; and T, tricuspid valve. Angelini 1999

References

Further reading on coronary artery anomalies

Angelini P, Villason S, Chan AV, Diez JG. Normal and anomalous coronary arteries in humans. In: Angelini P, ed. Coronary Artery Anomalies: A Comprehensive Approach. Philadelphia: Lippincott Williams & Wilkins; 1999: 52
Angelini P. Coronary artery anomalies: an entity in search of an identity. Circulation. 2007 Mar 13;115(10):1296-305
Villa AD, Sammut E, Nair A, Rajani R, Bonamini R, Chiribiri A. Coronary artery anomalies overview: The normal and the abnormal. World J Radiol. 2016 Jun 28;8(6):537-55.

Heart HQ

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Stuart Butterly

BSc (Hons) MBBS FRACP FCSANZ. Stuart is an interventional cardiologist and structural heart specialist. He has a special interest in treating complex and previously untreatable coronary artery disease, and a passion for distal radial artery access for coronary angiography and stenting.

After completing his training in Brisbane and Perth with an interventional cardiology fellowship, he returned to paradise to take up cardiology consulting at various local hospitals and now is a director of HeartHQ.

Peter Larsen

MBBS (Hons) FRACP FCSANZ. Peter is a clinical and interventional cardiologist with various special interests including coronary angioplasty and stenting, endovascular procedures and structural heart interventions. He studied and trained in Queensland and completed a Fellowship in Interventional Cardiology and Vascular Diagnosis in Boston, MA.

Peter returned home to become Director of Cardiology at Sunshine Coast Hospital, before becoming a founding partner and managing director of HeartHQ