“Superdominant” Left Anterior Descending Artery Continuing a
The present case has been reported in the journal Cardiology Research.

A 32–year-old male chronic smoker, non-hypertensive and non-diabetic, presented with acute onset retrosternal pain of 4-h duration with profuse sweating in primary health center. On examination, pulse was 80/min and blood pressure was 120/70 mm Hg. Electrocardiography (ECG) revealed ST segment elevation in inferior leads.

Patient was thrombolysed with intravenous streptokinase 15 lacs IU over one hour and then referred to tertiary care center for further management and coronary intervention. Patient laboratory parameters showed elevated cardiac enzymes. Chest radiograph showed no abnormality. Echocardiography revealed basal inferoseptal and inferior wall hypokinesia with left ventricle ejection fraction of 45%.

Coronary angiogram revealed PDA as a continuation of the LAD beyond the crux and the RCA, although normal in origin, was diminutive and terminated on the lateral wall of the right ventricle. LCX artery was also non-dominant. The LAD had plaque in mid-LAD course. Intravascular ultrasound study (IVUS) showed insignificant plaque (30% lesion) in mid LAD. Hence, it was decided to keep him on medical therapy.

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