RESUMEN

BACKGROUND: Techniques in endovascular therapy have evolved to offer a promising alternative to medical therapy alone for Type B aortic dissections (TBADs). AIM: The aim of this meta-analysis was to compare mortality and overall complications between thoracic endovascular aortic repair (TEVAR) and best medical therapy (BMT) in patients with TBADs. METHODS: We included randomized control trials and prospective or retrospective cohort studies that compared TEVAR and BMT for the treatment of type B aortic dissection. Multiple electronic databases were searched. RESULTS: Thirty-two cohort studies including 150,836 patients were included. TEVAR was associated with a significantly lower 30-day mortality rate than BMT (RR = 0.79, CI = 0.63, 0.99, P = 0.04), notably in patients ≥ 65 years of age (RR = 0.78, CI = 0.64, 0.95, P = 0.01). The TEVAR group had a significantly prolonged hospital stay (MD = 3.42, CI = 1.69, 5.13, P = 0.0001) and ICU stay (MD = 3.18, CI = 1.48, 4.89, P = 0.0003) compared to the BMT. BMT was associated with increased stroke risk (RR = 1.52, CI = 1.29, 1.79, P < 0.00001). No statistically significant differences in late mortality (1, 3, and 5 years) or intervention-related factors (acute renal failure, spinal cord ischemia, myocardial infarction, respiratory failure, and sepsis) were noted between the groups. CONCLUSION: Our meta-analysis revealed a significant association between the TEVAR group and a decreased mortality rate of TBAD compared to the medical treatment group, especially in patients aged 65 years or older. Further randomized controlled trials are needed to confirm our findings.

Asunto(s)

Aneurisma de la Aorta Torácica , Disección Aórtica , Procedimientos Endovasculares , Humanos , Procedimientos Endovasculares/métodos , Disección Aórtica/cirugía , Disección Aórtica/mortalidad , Aneurisma de la Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/mortalidad , Resultado del Tratamiento , Complicaciones Posoperatorias/epidemiología , Anciano , Aorta Torácica/cirugía , Reparación Endovascular de Aneurismas

RESUMEN

Intracardiac masses present a challenging diagnostic and therapeutic dilemma and are associated with an increased risk of complications, such as embolic events and obstructive symptoms. We report a novel procedure using an ONOCOR device through subclavian access that acted as a full-body protection device as well as a retrieval device.

RESUMEN

BACKGROUND: Exercise training is a well-established intervention for patients with heart failure with reduced and preserved ejection fraction. Still, the evidence of its effects on mortality, hospitalization, and quality of life needs to be more conclusive. We aim to evaluate exercise training clinical outcomes in patients with heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). METHODS: We searched five databases and three clinical trial registries for RCTs that compared exercise training plus usual care versus usual care alone in congestive heart failure (CHF) patients. We extracted data on all-cause mortality, hospital admission, heart failure hospitalization, and health-related quality of life measured by the Minnesota Living with HF questionnaire (MLHFW) and other scales. We pooled the data using random-effects or fixed-effects models, depending on the heterogeneity of the outcomes. We performed subgroup analyses for patients with heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF). RESULTS: We included 61 RCTs with 9062 participants. There was no mortality benefit, but exercise training improved health-related quality of life, reduced hospital admission at 12 months and longer follow-up, and reduced heart failure hospitalization. We observed substantial enhancement in health-related quality of life and a greater decrease in hospital admissions in the HFpEF group compared to the HFrEF group. CONCLUSIONS: Despite the lack of mortality benefit, exercise training is a beneficial intervention for CHF patients, improving health-related quality of life and reducing hospitalization.

Asunto(s)

Terapia por Ejercicio , Insuficiencia Cardíaca , Calidad de Vida , Volumen Sistólico , Insuficiencia Cardíaca/terapia , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/rehabilitación , Humanos , Terapia por Ejercicio/métodos , Volumen Sistólico/fisiología , Resultado del Tratamiento , Tolerancia al Ejercicio/fisiología , Enfermedad Crónica , Hospitalización

RESUMEN

Transcatheter extraction of an intracardiac mass is a newer approach that may lead to nonsurgical treatment of complex cardiac masses. We present a case in which thrombectomy devices were combined to extract a right atrial mass, which highlights new frontiers in the treatment of complex transcatheter mass extraction. The combined use of two transcatheter thrombectomy devices (Kong and Godzilla) may provide a powerful addition to the existing armamentarium.

Asunto(s)

Cateterismo Cardíaco , Neoplasias Cardíacas , Trombectomía , Humanos , Trombectomía/instrumentación , Resultado del Tratamiento , Neoplasias Cardíacas/cirugía , Neoplasias Cardíacas/diagnóstico por imagen , Cateterismo Cardíaco/instrumentación , Diseño de Equipo , Masculino , Femenino , Atrios Cardíacos/cirugía , Atrios Cardíacos/diagnóstico por imagen , Catéteres Cardíacos , Ecocardiografía Transesofágica

RESUMEN

Gerbode defect, an anomalous connection between the left ventricle and right atrium, is often congenital but can be acquired or iatrogenically formed. We present an exceedingly rare case of this defect associated with multiple valve perforation in an otherwise healthy patient with bicuspid aortic valve and endocarditis.

Asunto(s)

Enfermedad de la Válvula Aórtica Bicúspide , Endocarditis , Defectos del Tabique Interventricular , Humanos , Endocarditis/diagnóstico por imagen , Endocarditis/cirugía , Estado de Salud , Atrios Cardíacos

RESUMEN

BACKGROUND: Acute pulmonary embolism (PE) is a serious condition that needs quick and effective treatment. Anticoagulation therapy is the usual care for most PE patients but may not work well for higher-risk ones. Thrombolysis breaks the clot and improves blood flow. It can be given systemically or locally. Ultrasound-assisted catheter-directed thrombolysis (USAT) is a new technique that boosts clot-busting drugs. This network meta-analysis compares death, bleeding, and benefits of four treatments in acute submassive PE. METHODS: We comprehensively searched relevant databases up to July 2023 for RCTs. The outcomes encompassed all-cause mortality, major and minor bleeding, PE recurrence, and hospital stay duration. Bayesian network meta-analysis computed odds ratios (OR) and 95 % CI estimates. RESULTS: In this network meta-analysis of 23 RCTs involving 2521 PE patients, we found that SCDT had the most favorable performance for mortality, as it had the lowest odds ratio (OR) among the four interventions (OR 5.41e-42; 95 % CI, 5.68e-97, 1.37e-07). USAT had the worst performance for major bleeding, as it had the highest OR among the four interventions (OR 4.73e+04; 95 % CI, 1.65, 9.16e+13). SCDT also had the best performance for minor bleeding, as it had the lowest OR among the four interventions (OR 5.68e-11; 95 % CI, 4.97e-25, 0.386). CONCLUSION: Our meta-analysis suggests that SCDT is the most effective treatment intervention in improving the risks of All-cause mortality and bleeding. Thrombolytic therapy helps in improving endpoints including the risk of PE recurrence and the duration of hospital stay.

Asunto(s)

Fibrinolíticos , Hemorragia , Metaanálisis en Red , Embolia Pulmonar , Ensayos Clínicos Controlados Aleatorios como Asunto , Recurrencia , Terapia Trombolítica , Humanos , Embolia Pulmonar/mortalidad , Embolia Pulmonar/tratamiento farmacológico , Embolia Pulmonar/diagnóstico por imagen , Embolia Pulmonar/terapia , Embolia Pulmonar/diagnóstico , Terapia Trombolítica/efectos adversos , Terapia Trombolítica/mortalidad , Resultado del Tratamiento , Fibrinolíticos/efectos adversos , Fibrinolíticos/administración & dosificación , Hemorragia/inducido químicamente , Factores de Riesgo , Masculino , Femenino , Anciano , Medición de Riesgo , Persona de Mediana Edad , Factores de Tiempo , Adulto , Terapia por Ultrasonido/efectos adversos , Anciano de 80 o más Años , Tiempo de Internación , Anticoagulantes/efectos adversos , Anticoagulantes/administración & dosificación

RESUMEN

BACKGROUND: This meta-analysis compares His-Purkinje system pacing (HPSP), a novel cardiac resynchronization therapy (CRT) technique that targets the intrinsic conduction system of the heart, with conventional biventricular pacing (BiVP) in heart failure (HF) patients with left ventricular (LV) dysfunction and dyssynchrony. METHODS: We searched multiple databases up to May 2023 and identified 18 studies (five randomized controlled trials and 13 observational studies) involving 1291 patients. The outcome measures were QRS duration, left ventricular ejection fraction (LVEF) improvement, left ventricular end-diastolic diameter (LVEDD) change, HF hospitalization, and New York Heart Association (NYHA) functional class improvement. We used a random-effects model to calculate odds ratios (OR), and mean differences (MD) with 95% confidence intervals (CI). We also assessed the methodological quality of the studies. RESULTS: The mean LVEF was 30.7% and the mean follow-up duration was 8.1 months. Among LBBP, HBP, and BiVP, HBP provided the shortest QRS duration [MD: -18.84 ms, 95% CI: -28.74 to -8.94; p = 0.0002], while LBBP showed the greatest improvement in LVEF [MD: 5.74, 95% CI: 2.74 to 7.46; p < 0.0001], LVEDD [MD: -5.55 mm, 95% CI: -7.51 to -3.59; p < 0.00001], and NYHA functional class [MD: -0.58, 95% CI: -0.80 to --0.35; p < 0.00001]. However, there was no significant difference in HF hospitalization between HPSP and BiVP. CONCLUSION: LBBP as modality of HPSP demonstrated superior outcomes in achieving electrical ventricular synchrony and systolic function, as well as alleviating HF symptoms, compared to other pacing techniques.

Asunto(s)

Terapia de Resincronización Cardíaca , Insuficiencia Cardíaca , Humanos , Terapia de Resincronización Cardíaca/métodos , Volumen Sistólico , Función Ventricular Izquierda , Resultado del Tratamiento , Fascículo Atrioventricular , Electrocardiografía/métodos , Estimulación Cardíaca Artificial/métodos

RESUMEN

INTRODUCTION: The implantable cardioverter-defibrillator (ICD) was designed to detect and treat ventricular arrhythmias, which account for nearly half of all cardiovascular fatalities. Transvenous ICD (TV-ICD) complications were reduced by introducing subcutaneous ICD (S-ICD). S-ICD can be implanted using a three (3IT)- or two (2IT)-incision technique. This systematic review and meta-analysis was conducted to compare the 3IT to the 2IT. METHODS: We searched medical electronic databases of Cochrane Central, Embase, PubMed, Scopus, and Web of Science (WOS) from the study's inception until March 8, 2023. We compared 2IT and 3IT techniques of S-ICDs in terms of procedural, safety, and efficacy outcomes. We used Review Manager software for the statistical analysis. We calculated the risk ratio (RR) with its 95% confidence interval (CI) for dichotomous variables; and the mean difference with its 95% CI for continuous variables. We measured the heterogeneity using the chi-squared and I-squared tests. If the data were heterogeneous, the random-effect (RE) model was applied; otherwise, the fixed-effect model (FE) was used. RESULTS: We included three retrospective observational studies of 2076 patients, 1209 in the 2IT group and 867 in the 3IT. There was no statistically significant difference in erosion after S-ICD when 2IT compared with 3IT (RR = 0.27, 95% CI: [0.07, 1.02]; P = .05) (I2 = 0%, P = .90). There was no difference in risk of infection, lead dislocation, or inappropriate shock with either incision technique (RR = 0.78, 95% CI: [0.48, 1.29]; P = .34) (I2 = 0%, P = .71) and (RR = 0.37, 95% CI: [0.02, 8.14]; P = .53) (I2 = 66%, P = .05) respectively. Our meta-analysis showed that the efficacy of both techniques is comparable; Appropriate shock (RR = 0.94, 95% CI: [0.78, 1.12]; P = .48) (I2 = 0%, P = .81) and first shock efficacy (RR = 0.89, 95% CI: [0.44, 1.82]; P = .76) (I2 = 0%, P = .87). CONCLUSION: 2IT and 3IT of S-ICD have comparable efficacy and complication rates; however, the 3IT exposes patients to an additional incision without any additional benefits. These findings may provide clinicians with a simpler method for subcutaneous ICD implantation and likely result in improved cosmetic outcomes. Before the 2IT technique can be considered the standard of care, randomized controlled trials (RCTs) must be conducted to assess its long-term safety and efficacy.

Asunto(s)

Desfibriladores Implantables , Humanos , Resultado del Tratamiento , Cardioversión Eléctrica , Arritmias Cardíacas , Estudios Retrospectivos , Muerte Súbita Cardíaca

RESUMEN

Obesity is a global public health concern linked to premature death and an increased burden of noncommunicable diseases. This study aims to assess obesity-related mortality rates and temporal trends in the United States. We investigate variations by gender, ethnicity, and state-level demographics using data from the Centers for Disease Control and Prevention WONDER database spanning 1999 to 2021. We identified 124,076 obesity-related deaths, with a mean age-adjusted mortality rate (AAMR) of 2.7 per 100,000 population. AAMRs increased over time, with the highest rises observed in non-Hispanic Black/African American and American Indian/Alaska Native populations, and among males. Certain states showed higher AAMRs. These findings underscore racial disparities in obesity-related mortality and the need for further research to address these disparities.

Asunto(s)

Etnicidad , Obesidad , Grupos Raciales , Humanos , Mortalidad Prematura , Estados Unidos/epidemiología , Obesidad/mortalidad , Disparidades en el Estado de Salud

RESUMEN

His-Purkinje conduction system pacing (HPCSP) via His bundle pacing (HBP) and Left Bundle Branch Pacing (LBBP) offer a physiological approach to pacing by restoring normal ventricular activation. This meta-analysis compares the feasibility, outcomes, and success rates of HBP and LBBP in patients with atrioventricular block (AVB) and preserved left ventricular function. A systematic search identified studies comparing LBBP with HBP in AVB patients with preserved systolic function. Primary outcomes included QRS duration, success rates, pacing threshold, and improvement in R-wave amplitudes. Secondary outcomes were procedure time and fluoroscopy time. Random-effects models calculated odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CI). Methodological quality was assessed using the Newcastle-Ottawa scale. Among 382 screened articles, seven observational studies involving 1035 patients were analyzed. The mean age was 69.9 years, the mean LVEF was 59.3%, and the average follow-up duration was 8.7 months. LBBP showed higher R-wave amplitudes (MD 7.88, 95% CI 7.26 to 8.50, P < 0.0001) and lower pacing thresholds (MD -0.64, 95% CI -0.81 to -0.47, P < 0.0001) compared to HBP. LBBP had shorter procedure time (MD -17.81, 95% CI -30.44 to -5.18, P = 0.006) and reduced fluoroscopy time (MD -5.39, 95% CI -8.81 to -1.97, P = 0.002). No significant differences were observed in QRS duration or success rates. LBBP offers advantages over HBP, including improved electrical activation, lower pacing thresholds, and shorter procedure and fluoroscopy times. Success rates and QRS duration reductions were comparable between LBBP and HBP. These findings support LBBP as a feasible and effective alternative to HBP in AVB patients with preserved systolic function.

Asunto(s)

Bloqueo Atrioventricular , Humanos , Anciano , Bloqueo Atrioventricular/terapia , Bloqueo Atrioventricular/etiología , Fascículo Atrioventricular , Función Ventricular Izquierda , Estimulación Cardíaca Artificial/efectos adversos , Estimulación Cardíaca Artificial/métodos , Electrocardiografía/métodos , Resultado del Tratamiento

RESUMEN

Artificial intelligence (AI) offers a wide range of applications in clinical practice, and new technologies are rapidly evolving the healthcare industry and enhancing outcomes. Smartwatches represent the most popular type of wearable AI device that can assist people in detecting cardiac arrhythmias via constant monitoring of heart activity. Numerous advantages result from integrating AI into healthcare systems, including improved patient care, lower rates of medical errors, better treatment recommendations, and more accurate diagnosis of diseases. However, doubts still remain regarding the adoption of AI into patient care due to the challenges it poses. In this paper, we report a case of atrial fibrillation (AF) in a young patient that was detected by his smartwatch. We also highlight some of the benefits and challenges of AI applications in healthcare.

RESUMEN

Dyslipidemia is a common encounter in type 2 diabetes mellitus (T2DM) and the current strategies to manage it are still suboptimal. Subsequently, identifying newer molecules with lipid-lowering effects is necessary. A great deal of attention has been given in recent years to fiber supplements, e.g., guar gum. Thus, we screened and evaluated the quality of the evidence regarding the benefits of guar gum supplementation in T2DM and conducted a meta-analysis to assess the effects of this compound on serum lipids in T2DM. We conducted a comprehensive search in PubMed/Medline, Web of Science, Scopus, Google Scholar and Embase, from the inception of these databases until January 2021. In total, 11 papers were included based on the eligible criteria in our meta-analysis. The meta-analysis of the eligible trials demonstrated a significant reduction of total cholesterol (TC) (WMD: -20.32 mg/dL, 95% CI: -27.02, -13.62, P < 0.001) and low-density lipoprotein cholesterol (LDL-C) (WMD: -14.52 mg/dL, 95% CI: -20.69, -8.35, P < 0.001) following guar gum supplementation in T2DM patients. The subgroup analysis based on the dosage (g/day) of this compound revealed that ≥20 g/day of guar gum led to a notable decrease in triglyceride (TG) levels (WMD: -12.55 mg/dL, 95% CI: -23.72, -1.37, P = 0.02) versus < 20 g/day (WMD: -1.84 mg/dL, 95% CI: -32.18, 28.49, P = 0.90). Guar gum supplementation had no effects on high-density lipoprotein cholesterol (HDL-C) (WMD: 0.66 mg/dL, 95% CI: -0.95, 2.28, P = 0.42). Guar gum consumption has lipid-lowering effects when administered to patients with type 2 diabetes mellitus and it is particularly able to reduce TC, LDL-C and TG levels. Further research is however needed to confirm our findings.

Asunto(s)

Diabetes Mellitus Tipo 2 , Lípidos , Humanos , LDL-Colesterol , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Ensayos Clínicos Controlados Aleatorios como Asunto , Suplementos Dietéticos/efectos adversos

RESUMEN

Owing to performance-enhancing and cosmetic effects, illicit use of anabolic-androgenic steroids (AAS) has been well-described and can be associated with significant complications. We report a 27-year-old Caucasian male who self-medicated with AAS in the form of intramuscular injections and oral testosterone for a one-year duration. He complained of persistent jaundice and moderate generalized itching for one month. On admission, his total bilirubin level was 11.4 mg/dl (normal: 0-1.2 mg/dl), and liver enzymes were slightly elevated. On follow-up, the patient stated complete resolution of symptoms and near-normalization of lab results after one month of conservative management.

RESUMEN

Salmonella typhi infection can be associated with serious complications, ranging from self-limited to fulminant organ damage. In particular, liver and pancreatic damage may complicate the course of infection resulting in devastating outcomes. Enteric fever encompasses a tropical disease caused by Salmonellaspecies and can be associated with high morbidity and mortality. Invasive infection rarely presents with acute hepatitis and pancreatitis. Early recognition of associated clinical conundrums can improve prognosis in affected patients. Here, we present a case of acute hepatitis and pancreatitis in an otherwise healthy child.

RESUMEN

Diabetic ketoacidosis (DKA) is considered a medical emergency, most commonly associated with type 1 diabetes mellitus, and is relatively rare in type 2 diabetes mellitus (T2DM). We discuss a case of a 45-year-old woman with T2DM who presented to the emergency room with worsening lethargy and weakness. Before her presentation, her physician had recently added empagliflozin, a sodium-glucose cotransporter-2 (SGLT-2) inhibitor, to her anti-diabetic drug regimen along with glimepiride and a combination drug of vildagliptin and metformin. Based on the clinical examination and lab findings, DKA was suspected, but her glucose level was below the cutoff value for DKA diagnosis. However, her lab results showed significant metabolic acidosis and ketonemia with no clinical or laboratory features of sepsis. Therefore, the diagnosis of euglycemic diabetic ketoacidosis (eu-DKA) was made. She was successfully treated according to the DKA protocol and discharged in good condition. In this report, our aim is to discuss the relationship between SGLT-2 inhibitors with eu-DKA. Given the absence of significant hyperglycemia, recognition of this entity by clinicians may be delayed. Serum ketones should be obtained in diabetic patients with symptoms of nausea, vomiting, or malaise while taking SGLT-2 inhibitors, and SGLT-2 inhibitors should be discontinued if ketoacidosis is confirmed.

RESUMEN

Acquired hemophilia A (AHA) is an inhibitory coagulopathy that represents a rare variant of hemorrhagic syndromes. We present a case of idiopathic AHA in a 75-year-old male patient with a cutaneous hematoma that could be attributed to a recent COVID-19 vaccination. The aim of this report is to raise awareness of a possible association between AHA and COVID-19 vaccination and to review similar reported cases and management plans to prevent the development of possible morbidity and debilitating complications. This case illustrates an exceptionally rare side effect of the COVID-19 vaccination. The advantages of obtaining the COVID-19 vaccine outweigh the risks.

RESUMEN

The COVID-19 pandemic has markedly affected the health care of patients in low- and middle-income countries (LMICs), but no systematic study to corroborate this effect has been undertaken. In addition, the survival outcomes of patients with COVID-19 who received invasive mechanical ventilation (IMV) have not been well established. We pooled evidence from all available studies and did a systematic review and meta-analysis to assess and compare mortality outcomes between LMICs and high-income countries (HICs). We searched MEDLINE and the University of Michigan Library according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines from December 1, 2019, to July 15, 2021, for case-control studies, cohort studies, and brief reports that discussed mortality ratios and survival outcomes among patients with SARS-CoV-2 who received IMV. We excluded studies and case reports without comparison groups, narrative reviews, and preprints. A random-effects estimate of the arcsine square root transformation (PAS) of each outcome was generated with the DerSimonian-Laird method. Seven eligible studies, consisting of 243,835 patients with COVID-19, were included. We identified a significantly higher mortality rate (i.e., a larger PAS) among the patients receiving IMV in LMICs (PAS, 0.754; 95% CI, 0.569-0.900; P<.001) compared to patients in HICs (PAS, 0.588; 95% CI, 0.263-0.876; P<.001). Considerable heterogeneity was present within the individual subgroups possibly because of the extent of the included studies, which had data from specific countries and states but not from individual hospitals or health care centers. Moreover, the sample population in each study was diverse. Meta-regression showed that a higher mortality rate among patients with COVID-19 who received IMV in both HICs (P<.001) and LMICs (P=.04) was associated with chronic pulmonary disease. Our study suggests that chronic pulmonary diseases and poor demographics lead to a worse prognosis among patients with COVID-19 who received IMV. Moreover, the survival outcome is worse in LMICs, where health care systems are usually understaffed and poorly financed.

RESUMEN

Diabetes mellitus (DM) is a major cause of morbidity worldwide. The prevalence of DM has doubled over the last 35 years and is escalating. Various complications and manifestations of diabetes have caused numerous deaths worldwide, with numbers increasing every year. There have been many advances and breakthroughs over the past decade in the management of DM. The major focus of many research studies has been to evaluate effective medication combinations, preventative measures, and the way to control such morbid conditions. Our focus in this review is to discuss specific secondary prevention techniques with the diabetes log sheet and educational literature on its effectiveness in controlling diabetes. Hemoglobin A1c (HbA1c) has been accepted as a diabetes control measure in many resources worldwide. Here, we have assessed articles on the effectiveness of the diabetes log sheet and educational literature on HbA1c levels. We will begin with a few key points to acknowledge diabetes initially, followed by discussing the effectiveness of the diabetes log sheet and literature on HbA1c.

RESUMEN

Gastric cancer is one of the leading causes of cancer-related death worldwide. Helicobacter pylori (H. pylori) infection is known to cause gastric adenocarcinoma in a stepwise fashion. Gastric intestinal metaplasia is a known premalignant stage. We report a case of a 70-year-old male patient with active chronic H. pylori-associated gastritis and focal intestinal metaplasia on the initial presentation, who rapidly developed diffuse, poorly differentiated gastric adenocarcinoma 20 months after the loss to follow-up. Our case highlights the premalignant nature of gastric intestinal metaplasia (GIM) and the extreme importance of early eradication of H. pylori. We also address the lack of definitive GIM surveillance guidelines.

RESUMEN

Anomalies involving the origin of the coronary arteries are extremely rare, with the left main artery coronary artery (LMCA) originating from the right coronary sinus (RCS) one of its rarest forms. Anomalous origin of left main from right coronary sinus poses a high risk of sudden cardiac arrest. In our report, we shed light on the case of a 43-year-old female who suffered a witnessed cardiac arrest due to underlying anomalous origin of the left main artery from right coronary sinus. The patient was initially pronounced dead until return of spontaneous rhythm with concomitant myocardial infarction led to the diagnosis of anomalous coronary artery. This case stresses important points to consider when dealing with the acute management and chronic treatment plan for this subset of high-risk patients. We also consider the utility of mechanical circulatory support in the management of this condition.