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Hyperdominant left anterior descending artery (LAD) is a rare anomaly in which the LAD gives rise to the posterior descending artery. Our case report describes an extreme case of hyperdominant LAD supplying the anterior, inferior, and partially the lateral walls of the left ventricle. It is crucial that physicians be aware of the possibility of extreme LAD dominance. A proximal occlusion of such a vessel might have catastrophic consequences with atypical presentation on electrocardiogram.The column in this issue is supplied by George M D
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