Hyper-dominant left anterior descending coronary artery with continuation as a posterior descending artery-An extended empire

Hyper-dominant left anterior descending artery (LAD) is a rare coronary anomaly where LAD continues as a posterior descending artery. It is a rare coronary anomaly and there are only 19 cases reported so far in 17 case reports in the literature. Its involvement during acute coronary syndrome can be fatal as it leads to ischemia/infarction of a larger area of left and/or right ventricular myocardium. Its early recognition and management is essential with a high index of clinical suspicion.