Hyperdominant left anterior descending artery (LAD): A rare coronary anomaly.

Hyperdominant left anterior descending artery (LAD) is a rare coronary anomaly in which posterior descending artery arises from LAD instead of left circumflex or right coronary artery. Here we present a case of hyperdominant LAD presenting as acute myocardial infarction.

Case report

A 56-year-old female presented to our hospital with chest pain; ECG showed acute anterior wall myocardial infraction (AWMI) and the patient was taken for primary per-cutaneous coronary intervention (PCI). The angiogram showed nondominant right coronary artery (RCA) with 99% critical lesion of proximal left anterior descending artery (LAD) with nondominant left circumflex artery (LCX) (Fig. 1, Fig. 2). After predilation, it became clear that LAD is dominant and post-PCI shoot clearly showed LAD is continuing as posterior descending artery (PDA) (Fig. 3). Coronary artery anomalies are usually discovered incidentally and have an incidence of 0.2–1.2% in the general population. It is rare for the PDA to originate from the LAD even though continuation of the LAD around the apex is common. The clinical implication of this anomaly is that if this type of hyperdominant LAD is occluded, a large infarction of the anterior wall, septum and inferior wall would be expected to occur and may present as cardiogenic shock.

Fig. 1

Showing nondominant RCA.

Fig. 2

Showing critical lesion of mid-LAD shown in RAO cranial view.

Fig. 3

Showing hyperdominant LAD after primary PCI in RAO cranial view.

Conflicts of interest

The authors have none to declare.