Coronary Anomalies Flashcards¶
ALCAPA - Recognition¶
Q: What is ALCAPA? A: Anomalous Left Coronary Artery from Pulmonary Artery - left coronary arises from PA instead of aorta Tags: alcapa, definition, high-yield
Q: At what age does ALCAPA typically present? A: 2-4 months (as pulmonary vascular resistance falls) Tags: alcapa, presentation, high-yield
Q: What are "anginal equivalents" in an infant with ALCAPA? A: Irritability, pallor, diaphoresis with feeding or crying (infants can't report chest pain) Tags: alcapa, presentation, high-yield
Q: What is the classic ECG finding in ALCAPA? A: Deep Q waves in leads I and aVL (± V5-V6) - anterolateral infarction pattern Tags: alcapa, ecg, high-yield
Q: An infant has DCM, MR, and Q waves in I and aVL. What diagnosis should you suspect? A: ALCAPA - this is the classic triad Tags: alcapa, diagnosis, high-yield
Q: Why does ALCAPA cause mitral regurgitation? A: Papillary muscle ischemia from inadequate coronary perfusion Tags: alcapa, mechanism
Q: ALCAPA is often misdiagnosed as what conditions? A: Colic, reflux, bronchiolitis, myocarditis, or idiopathic DCM Tags: alcapa, differential
Q: What is "coronary steal" in ALCAPA? A: Blood flows from RCA collaterals INTO the low-pressure PA instead of perfusing the LV myocardium Tags: alcapa, physiology
Q: Why does ALCAPA present at 2-4 months and not at birth? A: At birth, PA pressure is high enough for adequate perfusion; as PVR drops, coronary perfusion becomes inadequate Tags: alcapa, physiology, high-yield
ALCAPA - Management¶
Q: What is the resident's role when ALCAPA is suspected? A: Treat as urgent, call cardiology immediately, supportive care for heart failure Tags: alcapa, management, resident-action
Q: What imaging defines coronary anatomy in suspected ALCAPA? A: CT angiography or cardiac catheterization (echo may not clearly show coronary origins) Tags: alcapa, imaging
AAOCA - Recognition¶
Q: What is AAOCA? A: Anomalous Aortic Origin of Coronary Artery - coronary arises from wrong aortic sinus Tags: aaoca, definition
Q: AAOCA is what rank among causes of SCD in young athletes? A: Second most common (after HCM) Tags: aaoca, scd, high-yield
Q: What are the two high-risk anatomic features in AAOCA? A: Interarterial course (between aorta and PA) and intramural course (within aortic wall) Tags: aaoca, anatomy, high-yield
Q: What is the mechanism of sudden death in AAOCA during exercise? A: Great vessels dilate during exertion, compressing the anomalous coronary → acute ischemia → arrhythmia Tags: aaoca, mechanism, high-yield
Q: What is the most concerning symptom suggesting AAOCA? A: Exertional syncope Tags: aaoca, presentation, high-yield
Q: What question should residents ask to assess AAOCA risk? A: "Did symptoms occur DURING exercise or AFTER exercise?" (during = higher concern) Tags: aaoca, history, high-yield
Q: Why might ECG be normal in a patient with AAOCA? A: Ischemia is dynamic and exertional; resting ECG may be normal Tags: aaoca, ecg, high-yield
AAOCA - Management¶
Q: What is the immediate action for exertional syncope in a young athlete? A: Restrict from all sports and obtain urgent cardiology evaluation Tags: aaoca, management, high-yield, resident-action
Q: What imaging is gold standard for defining AAOCA anatomy? A: CT angiography Tags: aaoca, imaging, high-yield
Comparison¶
Q: How do ALCAPA and AAOCA differ in typical age at presentation? A: ALCAPA = infants (2-4 months); AAOCA = children/adolescents (often athletes) Tags: alcapa, aaoca, comparison, high-yield
Q: How do ALCAPA and AAOCA differ in mechanism? A: ALCAPA = chronic ischemia from low-pressure perfusion + steal; AAOCA = dynamic ischemia during exertion Tags: alcapa, aaoca, comparison
Q: What is the key ECG difference between ALCAPA and AAOCA? A: ALCAPA has Q waves (chronic infarction); AAOCA usually has normal ECG at rest Tags: alcapa, aaoca, ecg, high-yield