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Case Report | DOI: https://doi.org/CCSRR-CR-25-35

Congenital Coronary Anomaly

Ramachandran Muthiah *

President of all Nations MBBS,MD(General Medicine),D.M(Cardiology),FNB (interventional cardiology),ACCF (belongs to all Nations) Morning star hospital, India

*Corresponding Author: Ramachandran Muthiah, President of all Nations MBBS,MD(General Medicine),D.M(Cardiology),FNB (interventional cardiology),ACCF (belongs to all Nations) Morning star hospital, India

Citation: Ramachandran Muthiah (2025). Congenital Coronary Anomaly, J Clinical Case Studies and Review Reports. 2(4) 35, DOI: CCSRR-CR-25-35

Copyright: Ramachandran Muthiah, et al © (2025). This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Received: 25 June 2025 | Accepted: 04 July 2025 | Published: 14 July 2025

Keywords: congenital coronary anomaly; treadmill testing; episodic ischemia; angiographic imaging

Abstract

The treadmill ECG stress test is commonly used as a screening test to identify myocardial ischaemia. During exercise, the physiological increase in heart rate is due to a decrease in vagal tone followed by an increase in sympathetic tone and the sufficient effort during treadmill ECG stress testing is defined as achieving 85% of the age-predicted maximal heart rate. The increase in sympathetic tone and vasodilation during exercise generally causes a rise in blood pressure.An exaggerated blood pressure response, defined as a peak systolic blood pressure of > 210 mmHg in men and > 190 mmHg in women  was shown to predict the risk of hypertension in normotensive individuals, A drop in systolic blood pressure > 10 mmHg is an indication to terminate the treadmill ECG stress tests, as it could be due to myocardial ischaemia leading to left ventricular dysfunction.In addition to the evaluation of CAD, the treadmill ECG stress test is also often used to evaluate for chronotropic incompetency, in which the patient is unable to mount an adequate heart rate response to exercise, leading to symptoms such as effort-related dyspnoea and lethargy.The Bruce protocol is the most commonly used andit consists of a total of seven stages, with a gradual increment in the speed and gradient of the treadmill. Each stage lasts three minutes to allow the patient to acclimatise to the specific speed and gradient before advancing to the next stage. The MET value increases as the patient advances to higher stages of the Bruce protocol. Exercise intensity during the treadmill ECG stress test is calculated in METs, which reflect the amount of oxygen consumed per minute. 1 MET is equal to 3.5 mL/min/kg of oxygen used. Continuous ECG monitoring is carried out throughout the test and into the recovery period to assess for any changes in the ST segments due to limitation of coronary blood flow may lead to myocardial ischaemia , as well as for arrhythmia. The test is often stopped before completing Stage 7, when the patient achieves the target heart rate or is symptomatic, or when the test is positive.The duration of ST-segment depression is also important, as prolonged recovery after peak stress is consistent with a positive treadmill ECG stress test. Another finding that is highly indicative of significant CAD is the occurrence of ST-segment elevation > 1 mm (often suggesting transmural ischemia) and these patients are frequently referred urgently for coronary angiography.

 A 46-year-old female developed anginal episodes during treadmill testing and further evaluation revealed a congenutal coronary anomaly.

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Sinisa franjic

i would like to thank the editorial team for their timely responses and consideration in the publication of my paper . I would encourage to publish there research in ScienceFrontier.

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Ritu Tiwari

I am pleased to submit my testimonials regarding the reviewer board and the editorial office. As a peer reviewer for the manuscript titled “A Novel Dissolution Method for Simultaneous Estimation of sennoside A and Sennoside B in Senna Tablet,” I was consistently impressed by the reviewers’ thorough analysis, insightful feedback, and unwavering commitment to enhancing the quality of the work. Their reviews were comprehensive and characterized by a respectful and collaborative approach, providing valuable suggestions that significantly improved the paper's outcome. Their dedication to the peer review process demonstrated their expertise and steadfast pursuit of excellence.

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Qader Bawerdi

With all due respect, I would like to express my opinion on the peer review, editorial support, and the quality of the journal as follows: The peer review was conducted quickly and with great care, and my article was accepted for publication in less than a week. The editorial support regarding the status of the article process was excellent, and they informed me every day until the acceptance of the current status of the article version, and regarding how to answer questions, the editorial support was excellent, timely, and friendly, and they answered questions as soon as possible and did not hesitate. The quality of the journal was excellent and it made me proud to be acquainted with the journal, and I sincerely look forward to extensive scientific collaborations in any field. I hope for increasing success and pride for the International Journal of Social Science Research and Review and all scientific and knowledge-based communities. Thank you

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Bhuvanagiri Sathya Sindhuja

"I would like to express my sincere appreciation for the opportunity to contribute to this esteemed journal. The publication process was smooth, well-coordinated, and the peer reviewers deemed highly professional. The editorial team demonstrated exceptional diligence and support at every stage, ensuring a seamless experience from submission to final publication. I am truly honored to be featured in such a reputable platform and look forward to future collaborations."

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Safana Abdullah Algutaini

Testimonial for the Journal of Biomedical Research and Clinical Advancements It was a truly rewarding experience publishing our study, "Single-Surgeon Outcomes of Left Ventricular Aneurysm Repair in Wartime Syria: A 10-Year Retrospective Study at Damascus University Cardiac Surgery Hospital," with the Journal of Biomedical Research and Clinical Advancements. The editorial and peer-review process was both rigorous and efficient, demonstrating a high standard of academic integrity and scientific scrutiny. The journal’s commitment to open access and global health equity is evident in its support of research emerging from conflict-affected and resource-limited settings—making our work not only visible but impactful. The professionalism of the editorial team, the speed of communication, and the clarity of submission guidelines all contributed to a smooth publication process. We were particularly impressed by the quality of the publication layout and the prompt indexing of our article, which enhances its accessibility to clinicians, researchers, and policymakers worldwide. We are proud to have contributed to this journal and highly recommend it to fellow researchers seeking a reputable platform to disseminate clinically significant and globally relevant findings.