Interestingly, when the variant is heterozygous, its effects can be observed beyond MMD, influencing the extracranial vessels.[6] Among these, numerous reports have highlighted an association between the onset of coronary heart disease and MMD.[7–10] However, there are no reports linking the RNF213 p.R4810K variant directly to patients with coronary heart disease. The gene discussed is RNF213; the disease is multiminicore myopathy.