A woman consulted due to chest pain. The electrocardiogram (Fig. 1) was compatible with ST-segment elevation acute coronary syndrome. Urgent coronary angiography was performed, showing a right coronary artery (RC) without lesions, and an anterior descending coronary artery (AD) with abundant thrombotic material, encompassing the root of a large diagonal branch (Dg) with small branches that irrigate the territory of a theoretical circumflex coronary artery (Cx) that could not be visualized. The coronary artery lesions were revascularized. Subsequently, coronary computed tomography angiography (Fig. 2) confirmed congenital absence of the Cx. The patient developed cardiogenic shock due to the large ischemic area.
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