Sudden death due to coronary artery anomalies: a case report and clinical review.

Congenital anomalies of the coronary arteries are relatively uncommon conditions with an incidence of approximately 2% in the adult population. Although less common than acquired coronary artery disease, these anomalies may be associated with myocardial ischemia and its consequences; angina, arrhythmia, infarction, and sudden death. A 21-year-old female patient with no significant prior medical history was found dead at home. Postmortem examination revealed high take-off of the right coronary artery with acute down-ward angulation of the proximal right coronary artery and acute downward angulation of the left main coronary artery. Microscopic examination revealed global myocardial ischemia consistent with a terminal ventricular dysrhythmia. There was no evidence of any other disease processes. Detailed toxicological investigation was negative. The Regional Forensic Pathology Unit experience with sudden death due to congenital coronary artery anomalies is presented along with a review of the current literature.