Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access
Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc
Journal website https://www.cardiologyres.org

Case Report

Volume 9, Number 4, August 2018, pages 253-257

“Superdominant” Left Anterior Descending Artery Continuing as Posterior Descending Artery: Extremely Rare Coronary Artery Anomaly

Figures

Figure 1.
Figure 1. (a) 12-lead ECG showing ST segment elevation in leads II, III and aVF with T wave changes in chest leads; (b) 12-lead ECG after thrombolysis with streptokinase. There is ST segment resolution with q wave in leads III and AVF with T wave changes in chest leads.
Figure 2.
Figure 2. Chest radiograph (posteroanterior view) shows no significant abnormality.
Figure 3.
Figure 3. Coronary angiogram showing left anterior descending artery (LAD) extending into the posterior interventricular groove. Note that the LAD wraps around the apex and gives rise to an anomalous large posterior descending artery (PDA).
Figure 4.
Figure 4. Coronary angiogram in the right anterior oblique (RAO) caudal projection showing left anterior descending artery continuing as posterior descending artery with non-dominant left circumflex artery.
Figure 5.
Figure 5. Coronary angiogram in the left anterior oblique (LAO) cranial projection showing that rudimentary (non-dominant) right coronary artery originates from the right coronary cusp.

Tables

Table 1. Timeline of Patient Presentation
 
DayTime (h)Events
Day 10 hOnset of severe chest pain
Day 14 hArrival at the emergency department of primary health center and diagnosed as inferior ST elevation myocardial infarction (STEMI)
Day 14½ hThrombolysis with streptokinase started
Day 112 hAfter stabilization in primary health center, shifted to tertiary care Hospital
Day 115 hCoronary angiogram was performed with intravascular ultrasound to LAD (IVUS study)

 

Table 2. Laboratory Profiles of Patient
 
Lab parameterPatient valueReference range
Hemoglobin13.2 gm/dL12 - 14 gm/dL
Total white blood cell count11.36 × 109/L4 × 109 - 10 × 109/L
Platelet count187 × 109/L100 × 109 - 300 × 109/L
Troponin I0.76 ng/mL0 - 0.2 ng/mL
Creatine kinase-MB14.53 ng/mL0.10 - 4.94 ng/mL
Total cholesterol4.8 mmol/L< 5.0 mmol/L
HDL0.82 mmol/L> 1.0 mmol/L
LDL2.84 mmol/L< 3.0 mmol/L
Triglycerides1.63 mmol/L< 1.7 mmol/L
HbA1c5.9%5.5-6.5%