Noncompaction cardiomyopathy and multiple coronary-cameral fistulae in an octogenarian

An 85-year-old man was admitted to the emergency department with chest pain. His electrocardiogram showed a right bundle branch block as well as increased voltages suggesting left ventricular hypertrophy and t-wave inversions consistent with a strain pattern (versus ischemia). He underwent echocardiography which showed regional noncompaction and associated hypokinesis. These findings led to coronary angiography which revealed multiple coronary-cameral fistulae involving all three coronary arteries. He was initially treated for acute coronary syndrome but after his diagnostic procedures this was narrowed to a beta blocker, to reduce myocardial oxygen demand, and an angiotensin-converting enzyme inhibitor due to the cardiomyopathy. Although the fistulae may have caused the patient's chest pain, intervention was not possible due to the diffuse nature of the fistulae. He did well in follow-up without the development of heart failure symptoms or continued angina. <Learning objective: Noncompaction cardiomyopathy and coronary cameral fistulae are two rare disorders that have even more rarely been described in a single patient. They may be a part of a spectrum of a single disease that results from arrest of the normal sequence of embryologic development of the heart. The management of the two conditions includes aspects of standard heart failure care as well as medical and possibly interventional therapy for coronary ischemia (angina) related to fistulae.>.