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MULTIMODALITY
MUSEUM IMAGE
Sinoatrial Nodal Artery
Arising from the Right
Posterolateral Artery:
A Rare Anatomical Variant
PARVIZ-ALI LOTFIAN, MD
ARUN UMESH MAHTANI, MD, MS
SEYED ZAIDI, MD
RICHARD GRODMAN, MD
ABSTRACT
We discuss a case report of a 66-year-old male with no prior cardiac history who presented
to the hospital with persistent hiccups and shortness of breath. Following a positive
nuclear stress test and cardiac catheterization, a rare anatomical variant of a sinoatrial
nodal artery originating from the right posterolateral artery was revealed.
CORRESPONDING AUTHOR:
Arun Umesh Mahtani, MD, MS
Department of Medicine,
Richmond University Medical
Center/Mount Sinai, Staten
Island, New York, US
arun.mahtani@nyu.edu
KEYWORDS:
coronary vessels; anatomical
variation; coronary circulation;
NSTEMI
TO CITE THIS ARTICLE:
Lotfian P-A, Mahtani AU, Zaidi
S, Grodman R. Sinoatrial Nodal
Artery Arising from the Right
Posterolateral Artery: A Rare
Anatomical Variant. Methodist
DeBakey Cardiovasc J.
2022;18(4):86-88. doi: 10.14797/
mdcvj.1109
*Author affiliations can be found in the back matter of this article
87Lotfian et al. Methodist DeBakey Cardiovasc J doi: 10.14797/mdcvj.1109
A 66-year-old male with no prior cardiac history
presented to the hospital with persistent hiccups, causing
shortness of breath. A nuclear stress test showed a fixed
perfusion defect involving the inferior wall, possibly due
to diaphragmatic attenuation artifact with no evidence
of stress-induced myocardial ischemia, and a mildly
decreased left ventricular ejection fraction of 44% (Figure 1).
Coronary angiography revealed two-vessel coronary artery
disease, 80% stenosis of the middle right coronary artery
(RCA), diffuse heavy calcification of the left anterior descen-
ding artery (LAD) involving the proximal and mid-portions
with 80% maximal stenosis, a small caliber left marginal,
and a sinoatrial (SA) nodal branch originating from the right
posterolateral artery (RPLA) (Figure 2 A, B).
Figure 1 Nuclear stress test showing fixed perfusion defect in the inferior wall possibly due to diaphragmatic motion artifact.
Figure 2 (A, B) Coronary artery angiography left anterior oblique view of the SA nodal artery arising from the right posterolateral artery.
SA: sinoatrial
88Lotfian et al. Methodist DeBakey Cardiovasc J doi: 10.14797/mdcvj.1109
TO CITE THIS ARTICLE:
Lotfian P-A, Mahtani AU, Zaidi S, Grodman R. Sinoatrial Nodal Artery Arising from the Right Posterolateral Artery: A Rare Anatomical Variant.
Methodist DeBakey Cardiovasc J. 2022;18(4):86-88. doi: 10.14797/mdcvj.1109
Submitted: 20 March 2022 Accepted: 01 August 2022 Published: 06 September 2022
COPYRIGHT:
© 2022 The Author(s). This is an open-access article distributed under the terms of the Attribution-NonCommercial 4.0 International
(CC BY-NC 4.0), which permits unrestricted use, distribution, and reproduction in any noncommercial medium, provided the original
author and source are credited. See https://creativecommons.org/licenses/by-nc/4.0/.
Methodist DeBakey Cardiovascular Journal is a peer-reviewed open access journal published by Houston Methodist DeBakey Heart &
Vascular Center.
The SA nodal artery, a branch of the main coronary
arteries, supplies blood to the SA node. The SA node is also
known as the natural pacemaker of the heart. In 60% to 70%
of cases, its blood supply originates from the RCA, and in
20% to 30% from the LAD and left circumflex coronary
artery (LCX). The SA nodal artery provides vital oxygen
and nutrients to the SA node, which is a key component in
heart contraction that originates the initial electrical signal
for atrial contraction.1 When originating from the RCA, the
SA nodal artery most frequently arises at a mean distance
of 1.2 cm (range 0.2–2.2 cm) from its beginning.2 In less
than 1% of cases, the artery originates from the distal RCA.3
The posterolateral artery, also known as the posterior left
ventricular artery, arises from the RCA in a typical dominant
circulation. It is a terminal branch that supplies the inferior
portion of the heart along with the posterior descending
artery (PDA). It can also arise from the LAD or LCX.4 Based
on available data, this the first documented case of an SA
nodal artery originating from the RPLA.
COMPETING INTERESTS
The authors have no competing interests to declare.
AUTHOR AFFILIATIONS
Parviz-Ali Lotfian, MD orcid.org/0000-0002-3041-9342
Department of Medicine, Richmond University Medical Center/
Mount Sinai, Staten Island, New York, US
Arun Umesh Mahtani, MD, MS orcid.org/0000-0002-2101-7157
Department of Medicine, Richmond University Medical Center/
Mount Sinai, Staten Island, New York, US
Seyed Zaidi, MD orcid.org/0000-0003-0112-3769
Department of Cardiology, SUNY Downstate Medical Center,
Brooklyn, New York, US
Richard Grodman, MD orcid.org/0000-0002-2983-950X
Department of Cardiology, Richmond University Medical Center/
Mount Sinai, Staten Island, New York, US
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