Two coronary artery fistulae in a patient with temporal arteritis and chest pain

Area of Science:

• Cardiology
• Vascular Medicine
• Internal Medicine

Background:

• Chest pain is a common symptom requiring thorough investigation.
• Coronary artery anomalies, such as fistulae, can present with diverse clinical manifestations.
• Temporal arteritis is a systemic vasculitis primarily affecting large and medium arteries.

Observation:

• A 59-year-old woman presented with cardiac-sounding chest pain.
• Coronary arteriography was performed to investigate the chest pain.
• Two previously undetected coronary artery fistulae were identified during the procedure.

Findings:

• The identified fistulae originated from the distal right coronary artery and the diagonal branch of the left coronary artery.
• Both fistulae were observed to drain directly into the left ventricle.
• The patient was also diagnosed with temporal arteritis.

Implications:

• The presence of coronary artery fistulae can be an incidental finding during cardiac investigations.
• Effective treatment of underlying conditions like temporal arteritis may resolve associated symptoms such as chest pain.
• This case highlights the importance of considering systemic inflammatory conditions in patients with unexplained cardiac symptoms.