Coronary Artery Anomalies - Exercise Recommendations

Exercise with Coronary Artery Abnormalities

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A coronary artery anomaly is a congenital abnormality (a defect present at birth) in which at least one of the coronary arteries has an abnormal location. The abnormality usually involves either the origin of the artery, or the path the artery takes. Depending on its anatomical characteristics, a coronary artery anomaly can be either entirely benign, or potentially dangerous.

    One unfortunate aspect of this condition is that some varieties of coronary artery anomaly can lead to fatal cardiac arrhythmias, especially during strenuous exertion. Thus, congenital abnormalities in the coronary arteries make up one group of cardiac conditions associated with sudden death in young athletes. Unfortunately, having a coronary artery anomaly can drastically curtail an athlete’s ability to participate in sports - at least, until he or she receives adequate treatment.

    How Does A Coronary Artery Anomaly Cause Problems?

    There are numerous varieties of coronary artery anomaly. Most commonly recognized, however, are anomalies in which the left coronary artery originates from the area where the right coronary artery originates, or vice-versa. These conditions are considered potentially dangerous.

    In such cases, the abnormal origin means that the artery forms a sharp angle that can "kink" during strenuous exercise, when there is more stress on the vascular system.

    The kinking can cut off the flow of blood to the heart muscle, which has the potential of producing fatal cardiac arrhythmias and sudden death.

    What Are The Symptoms?

    Some people with congenital coronary artery anomaly will experience symptoms during exercise, such as chest pain or shortness of breath, or sometimes loss of consciousness (syncope).

    However, as unfortunate as it is, sudden death is most commonly the first symptom.

    How Is This Condition Diagnosed?

    Most of the time the physical examination is normal, and unless the athlete describes symptoms during exercise, there is no reason for the doctor to suspect the condition. If the condition is suspected, it can sometimes be diagnosed with a cardiac MRI study or a cardiac CT scan, although a cardiac catheterization is still considered the gold standard for making the diagnosis. About 1 in 20 patients who has a cardiac catheterization for chest pain turn out to have a coronary artery anomaly.

    Coronary artery anomalies are associated in some patients with other types of congenital heart disease, including tetralogy of Fallot and transposition of the great arteries.

    If a congenital coronary artery anomaly is diagnosed, it can usually be treated effectively with cardiac surgery, to re-route or bypass the affected artery.

    What Are the General Exercise Recommendations For Young Athletes With Coronary Artery Anomalies?

    According to the 2005 36th Bethesda Conference on Eligibility Recommendations for Competitive Athletes with Cardiovascular Abnormalities, athletes who have congenital coronary artery anomalies should refrain from all competitive sports. However, after surgical correction of their condition, these individuals may again participate in competitive sports.


    Graham, TP Jr, Driscoll, DJ, Gersony, WM, et al. Task Force 2: congenital heart disease. J Am Coll Cardiol 2005; 45:1326.

    Lorenz EC, Mookadam F, Mookadam M, et al. A systematic overview of anomalous coronary anatomy and an examination of the association with sudden cardiac death. Rev Cardiovasc Med 2006; 7:205.

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