47🤠, symptomatic with an abnormal stress test (treadmill test - CP & ST depression at peak exercise). following angiogram... What are your next steps for evaluating this patient?

Cardiac CT to determine the coronary artery course

Anomalous left coronary arising from right sinus. Cardiac CT to rule out course. Looks like a benign septal course by Angio. Intracoronary imaging and physiology not that helpful here. Indications for intervention include ventricular arrhythmias and ischemia in perfusion testing.

Malignant LMS course is a myth based on couple old case reports. The PAP never goes higher than aortic pressure to compress LM.

CT angio to see retoraortic or interarterial course of the anomalous artery. The LCA is anomalous.

very nice case. -IVUS could help when you got the patient in cath Lab. Now I do Cardiac CT. A good one form JACC

This is very typical left main from the right sinus and has an anterior course. The septal perforators indicate an intraseptal course and is an indication for unroofing. If patient has sx of SOB/angina/ex arrhythmias, then surgery. CT angio is the next step.

CTCA

Coronary ct ANGIO

Take an AL and try and shoot the anomolus cx. If okay, cardiac CT to see whether PA compression

CT to determine anomalous LM course arising from right coronary sinus which is likely malignant course