Which physical findings are characteristic of anomalous left coronary artery from the pulmonary artery (ALCAPA)?

Updated: Aug 10, 2020
  • Author: Mary C Mancini, MD, PhD, MMM; Chief Editor: Syamasundar Rao Patnana, MD  more...
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Answer

If congestive heart failure (CHF) is present, the infant appears distressed and exhibits tachypnea, tachycardia, diaphoresis, and irritability.

Auscultation may demonstrate a systolic murmur of mitral valve regurgitation and, possibly, a diastolic rumble of relative mitral stenosis best located at the apical left precordial region. A moderate third heart sound may be heard.

Rarely, a soft continuous murmur may be detected at the upper left sternal border that is reminiscent of a coronary artery fistula or a small patent ductus arteriosus.

The left ventricular precordial impulse may appear prominent and displaced both inferiorly and laterally.

The second heart sound may seem narrowly split with increased intensity of the pulmonic component, if left ventricular failure causes pulmonary artery hypertension secondary to elevated left atrial pressure.

In cases of severe CHF, hepatic enlargement may be observed, and the peripheral pulses may be diminished in intensity secondary to low cardiac output.


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