Angina pectoris as the initial manifestation of an aortocaval fistula

Spontaneous aortocaval fistula is an unusual disorder associated with abdominal aortic aneurysms and with the onset of high-output heart failure. A novel case of spontaneous aortocaval fistula formation that presented with angina is described. Increased myocardial oxygen demand due to elevated myocardial wall tension, inotropic state, and heart rate is the apparent contributing factor. Clinical evidence of ischemic heart disease and heart failure resolved with surgical correction of the shunt. Spontaneous aortocaval fistula formation can be a precipitating cause of new-onset angina.