We report a rare case of Type IV dual left anterior descending artery (LAD) in 65 year old male nondiabetic, nonhypertensive and nonsmoker, with effort dyspnea NYHA class II presenting to OPD of Dept of Cardiology, AIIMS, Bhubaneswar for presurgical evaluation. Dual left anterior descending artery constitutes 1% of all abnormal coronary artery morphogenesis described by Morettin [1] and Spindola-Franco et.al [2]. Ours case which is one of the six variants of Dual LAD i.e. Type IV was first described in 1939 by Waterson et.al [3]in Sir James Mackenzie who had this type of distribution. Concept of this rare anomaly should be there in the mind of interventional cardiologists and cardiac surgeons when this anomaly develops artherothrombosis and limiting angina and needs a balloon or graft landing. Single LAD usually supplies 54% of the ventricular myocardium in normal persons but in this rare anomaly the same job is carried out by two LADs.

Keywords: Dual; Coronary; Angiogram.