Angina caused by coronary steal phenomenon

Abstract

A 58-year-old woman was referred for having chest pain, a heavy left arm and dyspnea on exertion, diminishing on nitroglycerin and/or rest. She smoked 25 cigarettes a day, had essential hypertension and a familial predisposition for cardiovascular disease. Her electrocardiogram was normal. An exercise test was negative for signs and symptoms of ischemia. Because of the typical chest pain and multiple cardiovascular risk factors a coronary angiogram was performed. After injection of all three of the coronary arteries, contrast material flowed at relatively high velocity into the left ventricular cavity through multiple coronary arterioventricular connections. None of the coronary arteries showed stenoses (Fig. 1). Arterioventricular fistulas, first described by Kinard [ [1] Kinard S. Hypoplasia of the coronary sinus with coronary venous drainage into the left ventricle by way of the Thebesian system. Chest. 1975; 68: 384-385 Crossref PubMed Scopus (26) Google Scholar ] in 1975 as Thebesian veins, are relatively rare abnormalities. Involvement of all coronary arteries is seldom. The angina of our patient was probably due to a “coronary steal phenomenon” and was effectively treated with a β-blocking agent.