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Abstract

Anomalous Left Coronary Artery from the Pulmonary Artery (ALCAPA) is a rare and serious congenital coronary anomaly typically identified in infancy. This case report details an unusual presentation of ALCAPA in a 49-year-old female who initially appeared as a routine case of anterior wall myocardial infarction (MI) complicated by symptom-free congestive heart failure. Advanced imaging revealed the anomalous origin of the left anterior descending artery from the pulmonary artery, confirming the diagnosis. While surgical correction is strongly recommended by the American Heart Association (AHA) guidelines, the patient opted for conservative management. This case underscores the importance of maintaining a high index of suspicion for congenital coronary anomalies in adult patients presenting with unexplained ischemic events. It also emphasizes the critical role of advanced imaging in ensuring accurate diagnosis and guiding appropriate management strategies.