Hyperdominant left anterior descending artery presenting as anterior wall ST segment elevation myocardial infarction: A rare coronary anomaly

We report on a 75 year-old man who presented with severe chest pain for four hours. Physical examination was unremarkable and he was haemodynamically stable. ECG done in the ED showed ST segment elevations along with Q waves in the anterior and inferior leads with T wave inversions. He was rushed to the catheterization lab where the left anterior descending (LAD) artery was 99%occluded in the proximal segment while distal left circumflex showed 50-60% lesion. He underwent primary percutaneous coronary intervention to LAD with drug eluting stent and made an uneventful recovery. The LADwas found to be wrapping around the apex and continuing as the posterior descending artery (PDA). To the best of our knowledge, there are few case reports on the continuation of LAD across the left ventricular apex as PDA in the presence of a normally arising but small right coronary artery.