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August 5, 1974

Accomplices in Crime

JAMA. 1974;229(6):690-691. doi:10.1001/jama.1974.03230440048035

In the anthropomorphic universe of medical terminology, where wounds can be "angry"; hepatitis, "aggressive"; ulcers, "silent" or "kissing," a "stealing" blood vessel is not likely to cause much surprise. We have already taken in our stride the subclavian, mesenteric, aorto-iliac, spinal, renal-splanchnic, and coronary "steals." It is when a therapeutic agent is implicated in the theft that our pulse quickens. After all, we have no wish to be accomplices in the crime.

Such a crime is the strongly suspected participation of vasodilating drugs in the coronary steal during acute myocardial infarction.

Coronary steal was first described by Effler et al1 not in association with a drug, but with an aberrant left coronary artery originating from the pulmonary artery. The higher pressure in the normal vessel caused the blood to flow through anastomosing collaterals into the left coronary artery and thence retrograde into the pulmonary artery. Ligation of the anomalous artery