One artery to rule them all: A case of single coronary artery arising from the right sinus of Valsalva.

A single coronary artery (SCA) is a rare congenital anomaly with an incidence of 0.024 - 0.066% in angiographies and potential implications for adverse events depending on the course of the anomalous artery. We present a unique case of a single coronary artery arising from the right sinus of Valsalva. A 77-year-old female presented to the emergency department with an ongoing 3-hour episode of palpitations and intermittent atypical chest pain over 1 week. Her medical history included hypertension and dyslipidemia. Electrocardiography revealed atrial fibrillation with rapid ventricular response, which was successfully managed with intravenous amiodarone and the diagnostic workup ruled out life threatening thoracic pathology including cardiac ischemia. A CT coronary angiography was performed due to the moderate pretest probability of coronary artery disease. The scan identified a single coronary artery with a common origin of the left main coronary artery (LMCA) and the right coronary artery (RCA), from the right sinus of Valsalva, classified as Lipton Type RII-A which is a benign variant. This case highlights the importance of identifying CAAs, which are often incidental but may have clinical relevance depending on the anatomical course and associated risk factors. Early and accurate diagnosis through advanced imaging techniques is crucial to guide appropriate management and ensure optimal outcomes for the patient.