Anomalous right coronary artery origin from the pulmonary artery (ARCAPA) coexisting with obstructive atherosclerotic disease of the left coronary artery.

Coronary artery anomalies arising from the pulmonary artery are rare, result in reversed flow in the affected coronary artery, and are commonly associated with myocardial ischemia in infancy or childhood. Uncorrected survival to adult age is rare. We present a 77-year-old individual with anomalous right coronary artery from the pulmonary artery (ARCAPA), diagnosed by coronary angiography, whose clinical presentation was governed by coexisting obstructive atherosclerotic coronary disease.