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A 37 year old woman without a history of any cardiac disease presented with an incidentally detected left precordial systolic murmur. There was an anterior wall hypokinesia on echocardiography but no signs of valvar or congenital heart disease. Exercise testing showed relevant anterior ST segment depression suggestive of exercise induced ischaemia. Cardiac magnetic resonance (MR) imaging demonstrated hypokinesia and an area of subendocardial late enhancement in the anteroseptal left ventricular myocardium indicating non-transmural myocardial infarction.
Contrast enhanced MR coronary angiography showed an anomalous origin of the left coronary artery from the pulmonary trunk (arrow), known as Bland-White-Garland syndrome. The right coronary is enlarged (arrowhead). Right coronary angiography confirmed the diagnosis with retrograde filling of the left coronary artery and connection to the pulmonary trunk.