A rare coronary anatomy comprising dual (Type IV) left anterior descending arteries and an anomalous left circumflex artery from the right coronary artery

We present the case of a rare coronary anomaly in a 64-year-old male who presented with exertional angina. The right coronary artery (RCA) was dominant, giving origin proximally to an anomalous left circumflex (LCX) artery and a left anterior descending (LAD) artery which supplied the conventional mid and distal LAD territory. The left main artery (LM) arose from the left coronary sinus and branched into a large first septal and an intermediate artery. There was associated non-critical atherosclerotic disease. We report this because of the rare division of the LAD area of supply by arteries from both coronary sinuses (dual LAD) with an anomalous LCX also arising from the proximal RCA. The clinical implications are discussed.