A 54-year-old diabetic man with exertional chest pain had ischemic EKG changes on exercise stress testing. Coronary angiogram (RAO view) showed 50% narrowing of the left anterior descending between the first two diagonals (D1 & D2) and again after the first septal branch (S1). The left circumflex was totally obstructed after the second obtuse marginal (OM2) with distal recanalization.
The right coronary had proximal and distal high grade stenoses as well. The patient had a right dominant system (60% of coronaries are right dominant), i.e. the poster descending was supplied by the right coronary (see coronary anatomy).
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