The clinical and angiographic spectrum of isolated, nondominant, left circumflex coronary disease.
Sixteen of 994 patients with arteriosclerotic heart disease and dominant right coronary arteries had isolated left circumflex obstruction. Of these, 6 patients had significant (75%) narrowing in the main circumflex, 10 in 1 or the marginal branches and 1 in the atrioventricular groove branch. Angina was mild in 5, moderate to severe in 8, and unstable in 1. Four patients had prior myocardial infarction (MI), and 1 had a recent MI complicated by posterior papillary muscle rupture. The EKG was normal in 5, showed an MI in 2, LBBB in 1, RBBB in 2, ST-T wave changes in 3, LVH in 2, and atrial fibrillation in 2. Left ventricular angiography performed in the right anterior oblique projection revealed normal contraction in 9 patients, apical hypokinesis in 4, posterobasal hypokinesis in 1, and diffuse hypokinesis in 2. The left ventribular end diastolic pressure was normal in 11 patients and elevated in 5. The cardiac index was normal in 12 patients and reduced in 2. Isolated, nondominant, left circumflex coronary disease is an uncommon entity in symptomatic patients. However, when present, it may produce significant clinical and hemodynamic impairment.
D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis; D009202:Cardiomyopathies / Q000175:diagnosis; D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging; D004562:Electrocardiography; D005260:Female; D006334:Heart Function Tests; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis; D010210:Papillary Muscles