An unusual cause of atrial fibrillation in a young active duty soldier

Area of Science:

• Cardiology
• Vascular Medicine
• Diagnostic Imaging

Background:

• Coronary artery fistula (CAF) is a rare congenital or acquired anomaly.
• Often asymptomatic, CAFs can present with dyspnea, reduced functional capacity, or arrhythmias.
• Diagnosis typically involves advanced imaging techniques.

Observation:

• A young, healthy active duty male presented with progressive dizziness and exertional fatigue.
• He experienced paroxysmal atrial fibrillation, despite an initially negative stress test.
• Coronary computed tomography angiogram revealed large coronary fistulas.

Findings:

• Large fistulas were identified between an aneurysmal right coronary artery and the coronary sinus.
• A dilated left circumflex artery showed probable collateralization to the coronary sinus.
• Cardiac MRI and catheterization confirmed the fistulas but showed no significant shunting.

Implications:

• This case underscores the importance of thorough investigation in young individuals with unexplained cardiac symptoms.
• Advanced imaging is crucial for diagnosing rare conditions like coronary artery fistulas.
• Understanding CAF presentation is vital for timely and accurate diagnosis and management.