LAD id dominant because it supplies 50% 0f the myocardium
The dominance of the coronary circulation (right versus left) refers to the artery from which the posterior descending artery originates and supplies the Atrio-ventricular node (AV node), and not the absolute mass of myocardium perfused by either.
Right dominance occurs in 85% to 90% of normal individuals.
Anomalous origins of the Coronary Arteries Which anomaly is the most common
Aberrant origin of the LCx from the RCA is generally felt to be of no clinical significance due to its posterior course to the left ventricle. This is the most common origin anomaly of the coronary arteries
Sudden death in a young patient can result from anomalous origin of the coronary arteries
“286 competitive athletes under age 35 in whom cardiovascular disease was shown to be the cause at autopsy, an anomalous coronary artery of wrong sinus origin was responsible for 13 percent of cases, being second in frequency to hypertrophic cardiomyopathy” higher for patients with AAOCA of the left coronary artery than with AAOCA of the RCA, especially in the absence of symptoms
best way to dx AAOCA is CTA
AMI Most cases of acute myocardial infarction (MI) are caused by rupture or erosion of a fixed atherosclerotic plaque associated with subsequent thrombus formation Atherosclerotic lesions causing MI as a result of plaque disruption or erosion are not necessarily severe and different degrees of obstruction can be seen on coronary arteriography in most cases.
Angina In most of the world, atherosclerotic obstruction of one or more coronary arteries (coronary artery disease) is the most common cause of myocardial ischemia. Other clinical conditions associated with a decrease in supply due to disease in one or more coronary arteries include coronary artery vasospasm, coronary microvascular disease, myocardial bridging, fibrosis, embolism, dissection, and arteritis. Left ventricular hypertrophy may result in a reduction in subendocardial blood flow and oxygen supply; this may result in angina. This may be particularly important with the development of arterial hypertension, which may increase left ventricular end-diastolic pressure, resulting in impairment of capillary flow in the subendocardium.