Late presentation of anomalous left coronary artery arising from pulmonary artery with acute coronary syndrome

Congenital anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is associated with early infant mortality and adult sudden death. The use of advanced cardiac imaging has resulted in an increase in the number of diagnosed ALCAPA cases, especially in the adult population, sometimes even asymptomatic. The extent of collateral circulation that develops between the right coronary artery (RCA) and left coronary artery (LCA) determines the outcomes. We present a case of hitherto undiagnosed case of ALCAPA, with first presentation as acute coronary syndrome (ACS) in young male.