Congenital absence of the left circumflex artery in a patient presenting with acute inferior myocardial infarction

The absence of the left circumflex artery (LCX) with the superdominant right coronary artery (RCA) is an uncommon congenital coronary artery anomaly. Further, the coexistence of the absence of the LCX and acute inferior myocardial infarction is extremely rare. A 50-year-old female patient with a history of hypertension was admitted to the emergency department with a complaint of ongoing precordial chest pain that had started 45 minutes earlier. Physical examination was normal except for bradycardia with a heart rate of 48. Electrocardiography showed complete atrioventricular block with ST-segment elevation in the inferior leads, with reciprocal ST-segment depression in the anterolateral leads (Fig. 1a). Conventional coronary angiography revealed a total occlusion of the mid segment of the RCA (Fig. 1b, Video 1), noncritical lesion of the left anterior descending artery (Fig. 1c, Video 2), and an absent LCX that could also not be shown with the aortography.