Single coronary

I every one  nice to find this forum...I am a 60 year old  male who has been very atheletic  my whole life...From track and cross country  to heavy weight lifting  for  30 years.....At the age of  50 I started  really  getting tired all the time and had very little energy..so quit everything  .....Have been talking to my doctors for 10 years telling everyone who would listen that it wasnt right to feel that way.......Any how  about  three months ago I had a reaction to nyquil   that sent me to the hospital...All the symptoms were the same as a heart attack   but all the test showed  no heart attack no stroke and no nothing.....They put a great cardiologist on my  case  and it has been a wirl wind of doctors since  .....Tons of test   3 trips to Mayo  Clinic   to meet the best  ACHD  doctor anywhere( in my opinion)   They have found that I have a right coronary artery only....  My  left coronary is missing  and both my  LAD  and  CX    are both attached to opposite sides of the right coronary  Have a few more test to go at Mayo in about a week  to have a TEE  they want to check the back of my heart...They  have told me that  as of now  they dont feel they need to do any kind of surgery....I guess if I were to have a question it would be will I some day in the near future need surgery  or can people live into there  80s and  90s   with this  if treated with meds ....

[kenkeith]

You are in consultation with the best surgeons and yu have a rare congentital anomaly of vessel configuration...,but you have vessels providing blood flow to the area normally supplied by the LAD.  For some insight, normally, the LAD is dominant vessels indicating vessel branches from the LAD to supply oxygenated blood to left side of the heart, etc.  Then there is the rightside (RCA) dominant and that helps feed the left side in conjuction iwth the left artery.  Then there can be a combination configuration!

Whether or not intervention is required ot supply blood to a deficit area with a bypass, stent or medication may require rigorous analysis of blood flow based on the branching pattern and vascular geometry of the full vascular circuit of interest. The surgeon may develope a novel method for the reconstruction of a full/partial  coronary vascular tree from partial measurements, etc.

Or intervention may not be very complex based on the fact your vascular system has been actively providing sufficient blood flow with the native geometry and intervention can be with a stent and/or medication...because the geometry is unusual that doesn't mean the configuration is inadequate!  If your system sustained viability with the heavy demand for oxygenated blood supply for so many years you may have an adequate workable system for the remainder of your life free from any serious cardiovascular events.  

Thanks for sharing, and if you have any further questions or comments you arfe welcome to reply.  Take care, and I wish you well going forward.

Ken

[bubbaben]

Thanks  for the info...  The surgeon at  Mayo that consulted did say  if  a regular bypass was tried it would not  take and the graft would die.....He  said if it comes down to it they would have to  sew  arteries  partway  closed to adjust the pressure  but as of now  dont touch it untill we r sure it is broke....They r trying to find out for sure where all the blood is coming from to supply the left side    but something is.....They also want to make sure that nothing is pinched off  anywhere around the heart  front or back.......Sounds like my only  issue in life will be to make sure I never get any kind of blockage in the artery......So far so good.....

[ed34]

I have heard of a missing Left circumflex and the right coronary artery is super dominant. In such cases, the right coronary artery feeds the right ventricle, back and front, and feeds the back of the left ventricle too. It also in many cases crosses over to feed the lower front of the left ventricle to make up for an inadequate Left Anterior Descending. I have never come across a missing Left Anterior Descending. It will be interesting and very informative if you would be kind enough to keep us informed as regards to your progress, and of course what they discover about the anatomical layout of your arteries.
Very interesting post, thank you for sharing.

[bubbaben]

I am not missing the LAD  its just not on the left side...  Both the LAD and the  CX  come out of the  right coronary  which they say is  huge...  The CX  is also huge  but the  LAD  is not as big as it should be....  The  cardiologist  came into to my  room  told me that didnt know how I was still alive  that I had a Pete  Maravich  Heart and  now that we know about it  everything should be fine  because I will be watched  for  ever  by  doctors......Thing is I feel good other than all the medicine they put me on now  to  keep  the heart rate down  the blood pressure down  and to keep cholestrol down.....Have always had  ( 40 years)  extremely high  tris and chol....and smoke  2 packs a day  even tho  I worked out.....There is no sign of artery disease  and no blockage to speak of  anywhere   ........I feel that  I have been very lucky   and that some one is watching over me.........When  I hear  more I will post it........PS  have not smoked in 3 months.....

[kenkeith]

Missing LAD indicates the LAD is not located in the usual configuration...it is a very rare condition. In fact this is the second case in reading and answering more than 10000 heart disease posts. As you can imagine it presents a challenge to determine what contibutaries provide the major source to probably a very diffuse supply with its many collaterals that apparently have served well for years even with rigorous exercise. To survive with a good functioning heart for many years is almost a miracle!

[ed34]

Thanks for that. You think that a lot of supply will be down to collaterals? and not more profound vessels that may have grown during the development of the heart? I suppose thinking about it, if larger vessels were present, they would have been seen on the angiogram. Does the LAD in such cases still originate from the LMS? or is it retrograde filled?

[kenkeith]

I know you have if I remember correctly, an unusual configuration with  vessels on the left side so you may have some insight from your experience.

I recently answered a post regarding ASD and the pulmonary artery went to the left side and the right side had a different course...."The left coronary artery was a branch of
the pulmonary artery. The right coronary artery filled from the aorta and was grossly dilated; after a shorter delay, the left coronary artery opacified via extensive
collaterals and the contrast was seen streaming into the main pulmonary artery".

I would assume the collaterals develop prior to birth and after birth when the heart is pumping on its own other collaterals may further develop to support the additional stress to the heart.

[bubbaben]

Not sure where all the blood is coming  from  but if  I made it this far  something is working......Trust me I am not complaining   extremely  rare can mean  good......I will see if I can get answer from Mayo  after the TEE  next week....  They think there may be  things they cant see from the front.....Who  knows....But  thank you guys and hope all goes well  for the both of  you

[ed34]

"I know you have if I remember correctly, an unusual configuration with  vessels on the left side so you may have some insight from your experience."

Well yes and no. The LMS was clear, as was the LCX. The proximal LAD was totally blocked which would have obviously killed me, but the distal LCX grew collaterals into the distal LAD and retrograde filled it. I think this is quite common though with blockages.

[bubbaben]

Final  Results  from  Mayo Clinic     Anomalous coronary artery anatomy..  One  right coronary ostium gives rise to the  RCA  a diminutive LAD and the left circumflex artery   ...Intra-arterial  intramyocardial LAD  course...The LAD  is diminutive and does not give rise to typical diagonals or septal  perforators...Those vessels arise from branches of the circumflex....Retroaortic course of the left circumflex coronary artery..In addition to supplying the typical circumflex territory this vessel also gives rise to a branch with an appearance similar to a typical first diagonal...This  "first diagonal"  also gives rise to the first septal perforator...Right coronary artery   There is a single right coronary ostium which gives rise to the  RCA  Left circumflex   LAD   and a conal branch...Right  dominant system with RCA  suppling a prominent  PDA.   LAD-  The LAD travels in an intra arterial   intra myocardial course  within the intraventricular septum before emerging into the epicardial fat to run in the interventricular  groove.....    Have no idea what this means but they dont seem as worried as I was so I will relax and wait now.....If  any one can explain in "not doctor "  terms  I would  appreciate it   Thanks   Rich

[curmudgen]

The only way to explain in "not doctor" terms is to have this anomalous pattern mapped out for you.  You should carry this description and ECG with you at all times...you never know when you will need to explain this unique pattern to a new doctor or in an emergency situation.

[ed34]

Well, first let's go through usual artery anatomy....
The Aorta (large artery from the Left atrium accepting pumped blood) has two coronary arteries attached. One is the Right Coronary Artery and the other is the Left Main Stem. The Left Main Stem would divide into the Left Anterior Descending and the Left CircumfleX. So both sides of the heart are fed by coronary arteries which originate on opposite sides of the Aorta.
In YOUR heart, I think they are saying....
There is only ONE coronary artery connection to the Aorta, the RCA. This vessel divides into three, the LAD(much smaller than expected), the Left Circumflex and the continuation of the RCA. So ALL your feeds come from one connection to the Aorta. 'Usually' the LAD gives rise to vessels called Diagonals which branch off to feed different areas of heart muscle. The Circumflex gives branches called Marginals. In your case, the LAD doesn't seem to have any major branches, but the Diagonals are on the Left circumflex instead. Your system is right dominated because the RCA supplies the Posterior Descending Artery, the one running down the back of the heart.

Personally, Although fascinating, I don't see that it would be a problem if the arteries are clear. Your arteries are laid out differently, but it doesn't mean they are less efficient.

[bubbaben]

Thanks  for the info ...Arteries are clear  had a calcium score of 7  and they say  mild  buildups....  On tricor and aspirin......life is good       Thanks    Rich

[kenkeith]

Rich,  Thanks for your response.  The thread will go to the archives, and will be available to you or anyone else who may have an interest.  An anomaly of vessel configuration can be the vessel originates from an abnormal source (LAD and ICX normally orginates from the Left Main) the right coronary ostium (shares source with RCA).  An anomaly configuration can relate to course of blood flow that is abnormal.  And your configuration is right dominant.

What is interesting is how much time by Mayo to map the blood flow.:)  Take care,

Ken

[bubbaben]

in Mayos defense  the info that I posted yesterday was done about 3 weeks ago  but I got a copy  recently when I saw my local cadio guy...Head for Mayo on Thurs.. for the TEE  so shoould have all the info I need...  I think most of my problems were with fear   Knowing I had something wrong but not being educated enough to know what it was .....I thank youfor all the info  and if anything changes in the future I will post...Rich

[boss100]

I have the same as bubbaben, single coronary artery, no LEFT, rare congentitial heart birth defect, did not know until 8 years ago when had funny feelings in chest and went to emergency room, was cathed and found, I had though heart palpitations, rapid hearbeat spells, and I was told it was so rare they wanted to do a journal on me, I would not allow it, I have reactions to beta blockers so I only take aspirin, I am a female 58 years old, I wake up in tach every day, live with spasms of the heart, and take nothing, bue a xanax.0.05 for the spasms, I have been told it is very rare, I have not found anyone like me until I found this website with bubbaben, I was told you can live long with what I have, but some days I would disagree with that, for the spells I have are not easy to get through the rapid heartbeat of tach, is very scary. I am glad to know I am not alone, now, I cannot take high heat, or extreme cold weather, I must rest when I am tired I was told not to push myself above a certain level of work, I have not listened to my heart doctor, I do what I want,but pay later, I never had a problem as a child or teenager or in my 30 or 40's began in my 50, change of life is making my heart palpitations horrible, NO HORMONES, they will not give them to me because they can cause heart attacks, so have to suffer through these hellish hot flashes. I wanted to have a right coronary put in, there is NO SUCH SURGERY AVAILABLE, I have been told, and that I am getting sufficient blood and oxygen flow, I beg to differ some days with that also. but I work legal and have much stress, so may be the cause, I hate having this, I am angry I have this, I have never heard of anyone with this until I read bubbaben's comments, I know I have horrible tach spells, I would wish on no one, and I know that just knowing I had this makes me know do I only half the life span of others, even the doctors don't really know,AT LEAST I THINK SO, what to do with me, they play it by ear, they say DON'T GET OVERTIRED, because anomalies have been associated with SUDDEN DEATH SYNDROME, I live from day to day, that all any of can do, I am a CHRISTIAN, still angry though that I have this, always asking WHY ME?  a pity trip I guess.  Boss100

[bubbaben]

Read your post ..I trully did not know it was that rare....The doctors I have  seen at Mayo  said  rare but I thought all coronary anomolies were rare....  Sorry to hear   what you r going thru....I do not have any v-tach  that has ever been documented  and just have mild  angina  occasionally.They have me on pills to lower the heart rate and more to lower the blood pressure which all seem to be working  plus 325 of aspirin and tricor for my tris which r high...I dont know where you see a doctor at  but I would hope it is at a good  adult congenital heart disease hospital....I have been getting tired for 20 years now and they tell me it has nothing to do with my heart....Please feel free to write back....Rich

[boss100]

Glad your wrote back, I have seen 6 cardiologist,  5 never cathed me, the last two did, only one cath in my life, found the rare congentitial heart birth defect of the single coronary artery, the tach, some days better than other, heat and cold make it worse, I take aspirin 81 mls when I remember to, but when having tach, chew up 4 to stop the tach and it works, The doctor who found my rare birth defect, could not believe it, he stated heart doctors live to see someone like me, wanted a journal , the second heart doctor, turn pale as a sheet when he watched my heart C D and and the third, was HEAD OF THE FORT GORDON HEART CENTER and he now has a grouping of heart doctors, I could have gone to MAYO in JACKSONVILLE OR DUKE IN NORTH CAROLINA, but he is the best, so why go any further, nothing can be done to change it, so I learned to live with it, had a terrible tach on Sat. taking an anitbiotic which kicked my tach in pretty bad, but got over it, I do have to some days pace myself and some days I go like the Energizer Bunny, Winter is my best time, I have less tach, winter here is mild, so never gets extremely cold, so I love winter. I would like to ask you, what are they giving you for the blood pressure, for I was put on NORVASC and had severe reaction, cardizem, had reaction, so now I take a just the 0.5 zanax  to lower pressure,  and walk, stay away from salt, I am person who believes food is your medicine, if all possible, I believe food heals, and food can kill you, so make the best selections and take food to heal all. I don't take the zanax unless absolutely can't get out of the tach, I believe food will heal any disease, and I have never taken the flu shot, have not had a cold in years and years, and years, the flu about 15 years ago, I think, believe in prayer and God, FOOD is medicine, if used right, love is another medicine, and meditation, harmony of the soul, with GOD and self heals more than you ever could get from a doctor, do you feel speical, I do, just being alive with what we have is a miracle, angry though sometimes, when in tach, but my thorn in the flesh keeps me closer to GOD, as Paul's thorn did, definitely a reason for both of us to be here, with such a rare heart. You are the first person in all the years I have searched the web to find someone like me, so you see, it is very rare. Tiredness can be depression, or not eating the right foods, B12  FOODS, eat plenty of them, and get wheat germ and eat it on everything, I do. I try organic foods mostly,  field peas, Southern style with olive oil, live on olive oil, lots of okra, you have to do something to get something, I always say, if you are overweight, you do without something, and underweight, you get something you need, the heart, oh it will always be the way it is, but just to know it functions like a normal heart for blood and oxygen, is so great, I do have the lungs of a man, where my heart lacked, my lungs developed larger as a woman, so  the body does compensate, how marvelous, the hot flashes are horrible, which I have learned what triggers them, so stay away from certain foods, just have to get in harmony with all your body tells, you, stress is killing the world, and making a buck is killing  the world, but here in the South we go slow, like turtles, one thing about here, you can drive for miles and never see a human being, deer, sure, humans no. But enough babbling, Had a C T SCAN two years ago, the doctor is still so amazed, still, what a heart, what a wonderful heart, he still states how rare I am. So we are two of kind, got me on a bad day, when I wrote first time, happiness and clown, must of the time, but some days, pray I make it through the tach spells, but hey. we have to sunshine with the rain, the tach days, makes me closer to the Lord. which ain't bad at all.
Keep me posted, on your rare heart and I will keep you posted on mine, God bless.

[bubbaben]

Mayo put me on 325 mg  aspirin tricor and niaspan  to keep everthing  clean of plague   also on  bystolic    indur  and  lisinopril   to keep the heart rate and blood pressure low.....Take zanax for panic attacks only  fro when i first found out......Taking it all better now    Have been told  if you made it past the age of 40  it probably  wont  kill you as long  as you keep chlo  tris  and plague  from building up...Have never had tach but know many people who have had it  and have it under control  with no other defects......Are you checked on a regular basis  like every 6 months by the doc you r seeing and do they run test   every so often just to stay on top of it.......I feel great  other than tired from the medicine  ....I  made it to 60  so cant see why i cant see 90 someday..... Stay in touch   Rich

[cupcake5]

hi boss I gave birth to a baby girl in sep and 12 hours later found out she had transposition of the great artery and a single right coronary artery. we were at Stanford hospital for three and a half months. We just recently got out and had a choice of going home or putting her on a heart transplant list.we decided to go home, she was so stressed out at the hospital .She has a eco on mon and depending how her heart function is doing we either stay home or go back to stanford. She is on 8 meds now. We are christian and have full faith in the Lord but sometimes I ask the whys and how did something like this happen to us. we have a healthy two year old boy so its so frustrating having a baby with a heart defect. I been wanting to meet anyone with this rare defect.

[pattystormy]

I have a similar problem with no left descending artery.  It wasn't found until I had a heart attack at 42.  I didn't even know I had had one, just the pain was bad under my arms.  I have been told even after a second HA that surgery is not something they would even consider since the rest of the heart is fine, so they are just treating me with RX.  I wish you much luck and it actually made me feel good to know someone else had the same problem.  I am now 58 and seem to be fine.  My last HA was at 49!  I also have a great cardiologist that came from the Mayo clinic here in Jacksonville, FL.  I feel very lucky he keeps tabs on me.  Take care!

[Twink44]

I, too have gone through extensive testing and was given the result at first that I had severe blockage and would be facing medicine, stents or open heart surgery based on the PET scan. But after the Heart Cath, the doctor was surprised by my right dominant coronary artery and no circumflex artery. Then they did a CTA scan and found I had no left coronary artery either. Not only that but the RCA rises in a tandem or double barrel fashion with the aberrant LAD. There are reversed or wrap-around apical branches from the RCA distribution assisting in apical perfusion. "No coronary disease which demonstrate no extrinsic compression along the retro-aortic courses." I have branches that have never been seen before and the doctor said it was hard to write it into my medical history because all heart branches have names and I have branches they have no names for. LOL
Have a great family doctor and cardiologist. Said he never saw anything like it in 27 years of practice. I was a little troubled when I heard my 3 options were more meds, stents or open heart surgery. To God be the glory for HIS fourth option: I'm just wired differently!  Carol

[ed34]

Thank you so much for sharing that Twink, it really is interesting what you wrote. Maybe you are the next genetic link in evolution :)