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[Demonstrated myocardial ischemia due to multiple coronary fistulae draining into the left ventricle]
R Gascueña Rubia1, F Hernández Hernández, J C Tascón Pérez
1Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid. hosoctubre@ms3.redestb.es
Insights
Multiple coronary fistulae, rare causes of myocardial ischemia, were identified in a patient. Beta-blockers effectively managed symptoms, suggesting a steal phenomenon.
Area of Science:
- Cardiology
- Vascular Medicine
Background:
- Multiple coronary artery fistulae are uncommon congenital anomalies.
- Coronary artery fistulae can lead to myocardial ischemia, though rarely documented.
Observation:
- A case of multiple coronary fistulae originating from the left anterior descending, circumflex, and right coronary arteries is presented.
- These fistulae drained directly into the left ventricle.
Findings:
- The patient exhibited myocardial ischemia, confirmed by thallium stress testing.
- Coronary angiography diagnosed the multiple coronary fistulae, presumed to be congenital in origin.
- Ischemia was attributed to a steal phenomenon, evidenced by symptom control with beta-blockers but not nitrates.
Implications:
- This case highlights a rare etiology of myocardial ischemia.
- The findings underscore the importance of considering coronary fistulae in unexplained ischemic events.
- Management strategies may differ based on the underlying mechanism, such as a steal phenomenon.
Abstract:
There are few cases of demonstrated ischemia due to the presence of multiple coronary fistulae. We report a case of multiple coronary fistulae from left anterior descending, circumflex and right coronary arteries draining into the left ventricle, which were responsible for myocardial ischemia demonstrated with thallium stress test. They were diagnosed by coronary angiography, and their etiology seems to be congenital. The final control of symptoms was achieved with beta-blockers, and not with nitrates, which speaks for a steal phenomenon as the cause of ischemia.