A Rare Case of Left Main Coronary Artery Coronary Sinus Fistula in an 85-Year-Old Female
Hanad Bashir1, Ahmed A Ahmed2, Mohammad Akhtar3
1Cardiovascular Medicine, The Christ Hospital, Cincinnati, USA.
Insights
Coronary arteriovenous fistulas (CAVFs) are rare in older adults. Evaluating CAVFs in geriatric patients with gastrointestinal arteriovenous malformations presenting with heart failure symptoms can improve diagnosis and treatment.
Area of Science:
- Cardiology
- Vascular Surgery
Background:
- Coronary arteriovenous fistulas (CAVFs) represent abnormal connections between coronary arteries and the cardiac venous system.
- While often congenital, CAVFs can also be acquired and may involve various cardiac structures.
Observation:
- A large fistula between the left main coronary artery and the right atrium was identified in a geriatric patient.
- This patient had a history of gastrointestinal arteriovenous malformations (AVMs).
Findings:
- Coronary arteriovenous fistulas are particularly infrequent in the geriatric population.
- Diagnosis typically occurs incidentally during investigations for symptoms like dyspnea or chest pain, often requiring coronary angiography.
- This case suggests a potential link between gastrointestinal AVMs and CAVFs in older adults presenting with high-output heart failure.
Implications:
- Evaluating for CAVFs in geriatric patients with a history of gastrointestinal AVMs and heart failure symptoms may be beneficial.
- Early identification can lead to simplified treatment strategies and improved interdisciplinary communication.
- Minimizing diagnostic delays and optimizing patient care are key goals.
Abstract:
Coronary arteriovenous fistulas (CAVFs) are congenital or acquired communications between the coronary arteries and coronary venous system, and they can also include other cardiac structures or vasculature. We discuss a case of a large fistula between the left main coronary artery and the right atrium in a geriatric patient with a history of gastrointestinal arteriovenous malformations (AVM). The occurrence of CAVFs, an uncommon cardiac irregularity, is particularly infrequent among older adults. Typically, it is discovered by chance when investigating symptoms such as shortness of breath or chest pain, where coronary angiography is necessary to determine the most effective treatment strategy. This case highlights the possible utility of evaluating CAVFs in patients with a history of gastrointestinal AVM who similarly present with clinical symptoms of high-output heart failure. Once identified, this could simplify the treatment approach and improve communication between healthcare providers to minimize the risk of harm to the patient.
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