A 63-year-old woman presented to the emergency department with chest pain. She subsequently underwent an evaluation with a diagnostic coronary angiogram that demonstrated a rare coronary anatomy. Instead of its usual bifurcation into two main branches--a left anterior descending and a left circumflex artery--her left main coronary artery quadfurcated into four branches: a left anterior descending artery, a left circumflex artery, and two ramus intermedii arteries. Possible implications of this unusual finding are discussed.
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