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

Shaikh, Shakil; Munde, Kalyan; Patil, Vishal; Phutane, Mukund; Singla, Rahul; Khan, Zahidullah; Bansal, Namita

doi:10.14740/cr738w

Cited by 6 publications

(4 citation statements)

References 7 publications

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“…As the blood supply to the entire interventricular septum is derived from this "hyper-dominant" LAD system, stenosis of LAD can be life threatening 6 . Musselman et al was the first to describe PDA originating from LAD and going up to crux similar to our case 7 . As mentioned in the similar literature by Jariwala et al there was abnormal PDA and other branches from RCA.…”

Section: Discussionsupporting

confidence: 77%

Hyper-dominant Left Anterior Descending Artery in the coronary circulation as a rare coronary anomaly

Pandey,

Karki,

Pandey

et al. 2023

Nepalese Heart J.

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Hyper-dominant left anterior descending artery is rarely seen in the coronary distribution. Its involvement in ACS can often be detrimental as it supplies most of the anterior and inferior part of the right and left ventricles in compared to other variants of LAD artery. It is required to be recognized earlier and management strategies should be ascertained. Our report here describes such a case of anomalous coronary artery which is less commonly encountered during Coronary Angiography. This was case of a 60 year old hypertensive male who presented with atypical chest pain had normal ECG, echocardiography and cardiac biomarkers but TMT was positive, subsequent Coronary angiographic evaluation came up with LAD artery which was going beyond apex in the posterior interventricular groove up to crux forming PDA with 20 to 30% stenosis in proximal to distal part. Such a large LAD running into the interventricular groove forming PDA is known as “Hyper-dominant” LAD artery. The Right Coronary artery was non-dominant. Fortunately, there was no signifcant coronary artery disease to explain the cause of his chest pain, but the artery had unusual distribution provided that it has sole territorial supply to larger part of the myocardium which can worsen the clinical status if coronary artery disease progresses. He was kept under medical management and was doing good. The “Take away” lesson is that there are very few subjects with Hyper-dominant LAD artery till date and most other cases with this anatomy had presented with myocardial infarction and thus such anatomical variant of LAD artery ought to be matter of concern and further research in the feld of cardiology.

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Section: Discussionsupporting

confidence: 77%

Hyper-dominant Left Anterior Descending Artery in the coronary circulation as a rare coronary anomaly

Pandey,

Karki,

Pandey

et al. 2023

Nepalese Heart J.

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show abstract

“…1 A notable area with considerable variation is the blood supply of the inferior and posterior myocardium, which determines coronary dominance. 8 To our knowledge, we report the first case of an extreme level of LADdominant circulation, with the LAD not only giving rise to the PDA but making a 180° turn at the crux and continuing apically as the PLA. In this sense, the LAD was truly hyperdominant, supplying the anterior wall, the overwhelming majority of the inferior wall, and even significant areas of the lateral wall via a large diagonal branch.…”

Section: Discussionmentioning

confidence: 78%

Extremely Hyperdominant LAD Supplying the Anterior, Inferior, and Lateral Walls of the Left Ventricle

Varga

Sharma

Styś

et al. 2020

Methodist DeBakey Cardiovascular Journal

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“…Although he patient had many risk factors for developing an acute cardiac event, including incidental pneumococcal pneumonia, he had no known coronary artery disease. His elevated troponin level and his ECG suggested an inferoposterior infarct due to a right coronary artery (RCA) occlusion because approximately 85% of the population has right-sided dominance [9]. However, the patient’s catheterization showed a small, normal, nondominant RCA and a normal, dominant left circumflex artery.…”

Section: Discussionmentioning

confidence: 99%

Acute inferior ST-elevation myocardial infarction due to delirium tremens: a case report

Mirande

Kubac²,

Nguyen³

2019

J Med Case Reports

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Background Delirium tremens is a severe form of alcohol withdrawal syndrome. Literature documenting acute coronary events in the setting of alcohol withdrawal remains scarce. An accepted hypothesis for the underlying process is focused on the hyperadrenergic state that leads to coronary vasospasm and increased myocardial oxygen demand. Case presentation A 47-year-old Caucasian man with a past medical history of tobacco and alcohol abuse, hypertension, and anxiety presented to the emergency department for crampy epigastric abdominal pain with intractable nausea and vomiting for the past 2 days. His reported last alcoholic intake was about 10 days prior; however, outpatient records indicated otherwise. He was admitted for electrolyte replacement and fluid resuscitation secondary to gastrointestinal losses from presumed early alcohol withdrawal syndrome. The following night, he developed acute substernal chest pain with elevated cardiac enzymes. Electrocardiography showed an acute inferoposterior infarct with reciprocal changes in leads V1–V4. The patient was taken for emergent catheterization, and a drug-eluting stent was placed in the middle of the left anterior descending artery. Postcatheterization electrocardiography showed sustained inferolateral ST elevations consistent with acute injury pattern. The patient had not required any benzodiazepines until this point. On the morning of catheterization, the patient’s Clinical Institute Withdrawal Assessment for Alcohol–Revised score was 19 with a high of 25, and he was actively hallucinating. He was treated for delirium tremens and an acute coronary event along with an incidental pneumonia. He did not require any benzodiazepines during the last 4 days of admission, and he made a full recovery. Conclusions The prevalence of alcohol dependence in hospitalized patients is substantial. Although our patient was being treated with the standard protocols for alcohol withdrawal, he rapidly developed delirium tremens, which led to an acute inferior ST-elevation myocardial infarction in the setting of nonoccluded coronary vessels. This case report adds to the sparse literature documenting acute coronary events in the setting of alcohol withdrawal and suggests that our patient’s ST-elevation myocardial infarction is not fully explained by the current coronary vasospasm hypothesis, but rather was in part the result of direct catecholamine-associated myocardial injury. Further research should be conducted on prophylactic agents such as β-blockers and calcium channel blockers.

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

Cited by 6 publications

References 7 publications

Hyper-dominant Left Anterior Descending Artery in the coronary circulation as a rare coronary anomaly

Hyper-dominant Left Anterior Descending Artery in the coronary circulation as a rare coronary anomaly

Extremely Hyperdominant LAD Supplying the Anterior, Inferior, and Lateral Walls of the Left Ventricle

Acute inferior ST-elevation myocardial infarction due to delirium tremens: a case report

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