Large Coronary Cameral Fistula to the Left Ventricle Presenting as Congestive Heart Failure
Yashitha Chirumamilla1, Ajit Brar1, Farouk Belal1
1Department of Internal Medicine, Hurley Medical Center, Flint, USA.
Insights
A rare coronary cameral fistula (CCF) was diagnosed in a patient presenting with chest pain and heart failure symptoms. This finding highlights CCF as a treatable cause of non-ischaemic cardiomyopathy.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Medical Imaging
Background:
- A 56-year-old female presented with intermittent chest pain, initially evaluated for coronary artery disease.
- Echocardiogram revealed a severely reduced ejection fraction (20-25%) and global left ventricular hypokinesis.
- Electrocardiogram showed ischemic changes and elevated cardiac troponins, prompting urgent cardiac catheterization.
Purpose of the Study:
- To report a case of coronary cameral fistula (CCF) mimicking ischemic cardiomyopathy.
- To emphasize the importance of considering rare coronary anomalies in the differential diagnosis of heart failure.
- To highlight CCF as a treatable cause of non-ischaemic cardiomyopathy.
Main Methods:
- Clinical presentation and diagnostic workup of a patient with chest pain and reduced ejection fraction.
- Cardiac catheterization and angiography to visualize coronary artery anatomy.
- Diagnosis of coronary cameral fistula and non-ischaemic cardiomyopathy.
Main Results:
- Cardiac catheterization revealed a large coronary cameral fistula (CCF) originating from a septal branch and extending into the left ventricle.
- The patient was diagnosed with non-ischaemic cardiomyopathy and heart failure with reduced ejection fraction secondary to the CCF.
- This case illustrates an alternative diagnosis to ischemic cardiomyopathy in a patient with concerning symptoms and initial findings.
Conclusions:
- Coronary cameral fistulas are rare anomalies that can present with symptoms mimicking ischemic heart disease.
- Increased awareness and reporting of CCF can aid clinicians in suspecting this condition as a cause of heart failure.
- CCF represents a treatable etiology of non-ischaemic cardiomyopathy, underscoring the need for comprehensive diagnostic evaluation.
Abstract:
A 56-year-old African American female was under evaluation for coronary artery disease by a cardiologist due to her complaints of intermittent chest pain. She underwent an outpatient echocardiogram and was found to have an ejection fraction of 20-25% with global left ventricular hypokinesis. Due to this finding along with her ongoing chest pain, she was referred to the emergency department for further evaluation. Her electrocardiogram showed changes suggestive of ischaemia and her cardiac troponins were mildly elevated, so she underwent an urgent cardiac catheterisation. The angiography confirmed the reduced ejection fraction and global left ventricular hypokinesis, but also demonstrated a large coronary cameral fistula (CCF) extending from the first septal branch into the left ventricle. She was then diagnosed with non-ischaemic cardiomyopathy and heart failure with reduced ejection fraction secondary to the CCF. In this report, we illustrate a frequently encountered clinical scenario in which a patient presented with chest pain and EKG findings indicative of ischaemic cardiomyopathy. The patient also had several risk factors for coronary artery disease, however further investigation revealed an alternative diagnosis.
Learning Points:
A description of rare coronary anomalies adds to the fund of medical knowledge and can guide physicians to make evidence-based decisions regarding its management.Increasing description of coronary cameral fistula will alert clinicians to suspect it as a cause for worsening heart failure and as a treatable cause of non-ischaemic cardiomyopathy.
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