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Heart failure with transient left bundle branch block in the setting of left coronary fistula

Stephen P Juraschek1, Lara C Kovell, Ryan E Childers

  • 1Department of Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, 4940 Eastern Avenue, Baltimore, MD 21224, USA.

Cardiology Research and Practice
|February 19, 2011
PubMed

Insights

Coronary arterial fistulas, rare heart vessel communications, can mimic myocardial ischemia. This case highlights a left anterior descending artery-to-pulmonary artery fistula presenting as heart failure and left bundle branch block, resolving with treatment.

Area of Science:

  • Cardiology
  • Vascular Medicine

Background:

  • Coronary arterial fistulas are uncommon abnormal connections between the heart's chambers or vessels.
  • They are rarely considered in the diagnosis of acute myocardial ischemia, despite potential cardiac symptoms.

Observation:

  • A 64-year-old male presented with left shoulder pain, heart failure symptoms, and new left bundle branch block (LBBB).
  • Cardiac catheterization identified a small left anterior descending (LAD) artery-to-pulmonary artery (PA) fistula.

Findings:

  • Diuretic therapy improved the patient's symptoms, and the LBBB resolved within days.
  • The fistula was hypothesized to cause transient ischemia via a coronary steal mechanism in the LAD territory.

Implications:

  • Coronary fistulas should be considered in the differential diagnosis of acute myocardial ischemia, especially with atypical presentations.
  • Conservative management may be appropriate for asymptomatic or stable fistulas, with resolution of symptoms following treatment of associated conditions like heart failure.

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