An Unusual Cause of Aborted Sudden Cardiac Death in a Middle-Aged Female Marathoner.

Although most congenital coronary artery anomalies have no prognostic implications, associations with sudden cardiac death have been described, particularly in the young. We report an exercise-associated collapse in an otherwise asymptomatic middle-aged female marathoner. The aborted sudden cardiac death approach revealed an unexpected initial presentation of a malignant anomalous left main coronary artery origin, with ostial stenosis and interarterial course. The present case illustrates an unusually longstanding coexistence of a malignant anatomical variant with a persistent trigger.