BMJ Case Reports 2013; doi:10.1136/bcr-2012-007800
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Bag of worms in coronary angiogram: an interesting case of right coronary artery collateral circulation

  1. Rangaraj Ramalingam
  1. Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
  1. Correspondence to Dr Sunil Srinivas, sunilbmc98{at}


A 35-year-old man presented with effort angina for 3 months. He was a chronic smoker and had a history of anterior wall myocardial infarction 6 months before admission. He was not thrombolysed and managed conservatively at that time and, since then, he was on medical treatment.

Examination did not reveal any significant findings. Electrocardiogram showed q waves with T wave inversions in anterior chest leads. Echocardiogram showed regional wall motion abnormality in the anterior wall and septum with ejection fraction of 45%. Coronary angiogram revealed total occlusion of left anterior descending artery (LAD) at the ostium (figure 1). Distal vessel was formed by Rentrope Grade II collaterals from both left circumflex and right coronary …

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