an anomalous origin of left anterior descending coronary artery from right coronary artery in a patient with acute coronary syndrome

a double left anterior descending (lad) coronary artery emerging from the left and right coronary arteries is classified among rare coronary anomalies. we herein report a 73-year-old man presenting with acute coronary syndrome (posterolateral myocardial infarction). he was admitted with typical chest pain, and due to his progressive ischemic changes on electrocardiography (ecg) and elevated cardiac enzyme, he was candidated for cardiac catheterization. the coronary angiography revealed an anomalous lad from the right sinus of valsalva. the unusual coronary anatomy was perfectly matched with the distribution of ischemia and its clinical evidence on echocardiography and ecg. the culprit lesion was stented, and the patient was discharged in good physical condition from the hospital.