history of chest pain, intermittent, radiating to
back and left arm with associated nausea and diaphoresis and dyspnea.

CTA of the coronary arteries reveals an anomalous origin of the right coronary artery which lies above the left sinus of Valsalva subtending the left coronary artery. It subsequently runs an interarterial (malignant) course between the pulmonary outflow tract and pulmonary artery and the aorta.

Proximally, at its origin, the RCA measures approximately 4 mm. As
it enters the space between the pulmonary artery and aorta, it takes an approximate 90 degree turn becomes mildly narrowed, (2.5 mm) and as it exits the space, it returns to its original diameter of about 4 mm.

No calcific atherosclerotic disease is identified. Agatson score equals 0

Right dominant coronary artery

Normal LV function (ejection fraction 60%) and RV function (ejection fraction 40%) with normal LV mass