Hyperdominant left anterior descending artery presenting as anterior wall ST segment elevation myocardial infarction:...

Area of Science:

• Cardiology
• Anatomical Variations
• Interventional Cardiology

Background:

• Coronary artery anomalies are uncommon and can present with diverse clinical manifestations.
• Anatomical variations in coronary artery origins and distributions can impact myocardial perfusion and diagnostic interpretation.
• Understanding these variations is crucial for accurate diagnosis and effective treatment of ischemic heart disease.

Observation:

• A 75-year-old male presented with acute chest pain and ECG findings indicative of myocardial infarction.
• Cardiac catheterization revealed a 99% occlusion in the proximal left anterior descending (LAD) artery.
• A unique anatomical finding was the LAD artery wrapping around the apex to supply the territory typically supplied by the posterior descending artery (PDA).

Findings:

• The patient underwent successful primary percutaneous coronary intervention with a drug-eluting stent to the occluded LAD artery.
• The coronary angiogram demonstrated an anomalous LAD artery coursing over the apex and continuing as the PDA.
• A normally arising but small right coronary artery was also noted, highlighting a rare coronary anatomy.

Implications:

• This case underscores the importance of recognizing rare coronary artery anomalies during percutaneous coronary intervention.
• Accurate identification of anomalous coronary anatomy can prevent procedural complications and optimize treatment strategies.
• Further case reports on such variations can enhance the collective understanding and management of complex coronary artery disease.