CASE REPORT
We report a case of congenital atresia of LMS in a 75-year-old male, presenting with acute severe chest pain on exertion, without prior cardiac symptoms whatsoever. His risk factors included hypertension, hypercholesterolemia and smoking.
The electrocardiogram demonstrated ST elevation in the anterior leads, and cardiac enzymes were positive, leading to emergent coronary angiogram. The latter demonstrated what was initially thought to be severe LMS stenosis with retrograde filling through right coronary artery (Figure 1). There were failed attempts to engage the LMS during aortic root injection. An ectatic right coronary artery was visualised which filled the the left side retrogradely.