A 65 year old housewife presented to our hospital with occasional left chest pains at rest. Bruits were heard from the bilateral carotid, brachial, and lower abdominal area. All arterial pulses of the extremities were noted to be normal and there was no coldness, cyanosis, or ulcer formation of fingers and toes. Although an ECG showed incomplete right bundle block and the Master’s exercise tolerance test was negative, coronary angiography was performed.

Angiography of the right axillary brachial artery was done before coronary angiography because it was difficult to insert a catheter through the right brachial artery. The angiogram showed the characteristic appearance of fibromuscular dysplasia (fig 1). Coronary arteriograms revealed tortuous but normal coronary arteries (fig 2).