Abstract
Chest pain is one of the common complaints a patient presents to the healthcare provider. It needs prompt evaluation to determine the cause and origin. Angina occurs when myocardial oxygen demand exceeds oxygen supply; the clinical manifestation is often chest discomfort. Atherosclerotic disease is the major cause of angina. However, several non-atherosclerotic conditions have been studied and reported in the literature that causes angina in rarity. We describe a case of coronary artery fistula (CAF) likely causing angina.
Highlights
Coronary artery fistulas (CAFs) are one of the significant congenital anomalies bypassing the myocardial capillary bed forming a communication between a coronary artery and either a chamber of the heart or any systemic or pulmonary circulation [1] The incidence of coronary artery fistula (CAF) and coronary anomalies is anywhere around 0.002% and 0.2 to 1.2% of the general population [2,3]
We describe a case of coronary artery fistula (CAF) likely causing angina
CAF has hemodynamics of an extracardiac left to right shunt when it connects to a right-sided cardiac chamber and resembles aortic insufficiency when connects to a left-sided chamber [8]
Summary
Coronary artery fistulas (CAFs) are one of the significant congenital anomalies bypassing the myocardial capillary bed forming a communication between a coronary artery and either a chamber of the heart or any systemic or pulmonary circulation [1] The incidence of CAF and coronary anomalies is anywhere around 0.002% and 0.2 to 1.2% of the general population [2,3]. The chest pain was heavy, retrosternal, constant for 30 minutes, non-radiating associated with dizziness, nausea, and palpitations It relieved gradually with rest after presenting to the emergency room. The differential for a patient presenting with chest pain and continuous murmur includes ruptured sinus of Valsalva aneurysm, patent ductus arteriosus, anomalies of coronary artery origin, aortopulmonary septal defect, ventricular septal defect, Lutembacher syndrome, and CAF. Cardiac catheterization showed insignificant coronary artery disease but revealed a fistula leading from the left coronary artery (LCA) near the bifurcation to the main pulmonary artery (PA) as seen in Video 1. The structural team deemed the transcatheter approach unsafe in our patient due to the large bore of the fistula, multiple branches communicating from LAD to the PA, and the close proximity of the fistula to the left-main. This resulted in patient recovery without any complications, and he remained asymptomatic
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