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Collateral circulation. Over time, in a stressed heart with blocked vessels, the heart circumvents or develops new pathways for blood flow. But of course, all that does it buy a little more time before the inevitable happens. The reason an LAD infarct is usually lethal is because the left anterior descending artery supplies a critical bundle of nerve fibres with blood flow; stop blood flow, stop nerve innervation, stop heart. But yeah, he would have survived because being such a fucking slob for so long he likely had enough collateral circulation to sustain him until he got treatment.
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