The mural left anterior descending coronary artery, strenuous exercise and sudden death.

Postmortem studies of three ostensibly healthy persons whose unheralded death occurred incidental to strenuous exercise revealed an obstructed but mural left anterior descending (LAD) artery, diminished vascularity to the posterior left ventricle and ventricular septum, and morphologic evidence of patchy, ischemic necrosis of the ventricular septum in different stages of healing. Although mural coronary arteries are considered a normal anatomic variant, our observations, coupled with reported clinical studies, strongly suggest that systolic constriction of the LAD artery may precipitate death in selected subjects.