What do you think about this LAD?

TIMI 2 flow in wrape arround lad. Could be due to 1. Endothelial dysfun 2. High EDP 3. Slo flow 4. Air embolism 5.rupture plaque with thrombus

Exception to the Rule ; Slow Steady Wins the Race... 😁 Metabolic Syndrome, Syndrome X, Endothelial Dysfunction, OSA, Hypercoagulable states etc come to decision making.

Type 4 LAD with decrease in coronary perfusion pressure due to high LVEDP

Very dominant LAD with slow flow! Any recent viral infection?

No history. Presented with chest pain.

Diffuse endothelial dysfunction. I would treat with anti platelets and statin. Nebivolol improves endothelial function

🫀⚡Chest pain, no obstructive lesions, depending on the patient's context = INOCA or MINOCA...!!! 🧐🤔😷🇲🇽

Since slow flow affects both LAD and LCx, assuming normal BP during exam, I would think of INOCA/MINOCA. This cine can be seen in cases of air embolism, also. I would confirm slow flow with intracoronary adenosine/CCB/nitrates. ACh test and CFR, if available, would be interesting

Wrapping around the apex with sluggish flow

TIMI II FLOW. just more long cine to see Distal LAD >CX