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Anomalous coronary artery origin is a rare clinical entity with varied clinical outcomes ranging from asymptomatic to sudden cardiac death. The incidence of anomalous origin of left coronary artery arising from the right coronary cusp is 0.3-1%. CT angiography is the choice method for coronary anomalies, but often coronary angiography in RAO (right anterior oblique) view shows the coronary course. We present a case that referred to our hospital with post myocardial infarction angina for coronary angiography. A resting 12-lead electrocardiogram showed ST-segment elevation in leads v2, v3, v4. A transthoracic echocardiogram indicated LVEF 25% (Left ventricular ejection fraction), septal akinesia and apical dyskinesia. Coronary Angiography showed an anomalous origin of the left coronary artery from the right coronary cusp and significant stenosis in LAD (left anterior descending) and LCX (left circumflex) arteries with poor run off.

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Temporary pace marker (TPM) usually has been used in emergency conditions. Insertion of TPM is accompanied with vein thrombosis and pulmonary Emboli. TPM was inserted via right femoral vein in 73 years male due to complete heart block. Thereafter, he was suffered from deep vein thrombosis. Echocardiography revealed multiple mobile clots in right atrium, ventricle and impending pulmonary thromboemboli following insertion of permanent pacemaker. Despite of contraindication for the application of thrombolytic agents due to surgical incision for permanent pacemaker and presence of patent foramen oval, the patient survived from massive pulmonary thromboemboli and death due to rapid diagnosis and on time treatment with anticoagulation agents without performing surgery.