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New-Onset Atrial Flutter Revealing a Large Right Coronary Artery to Superior Vena Cava Fistula
Sankalp Acharya1, Vyoma Patel2, Sai Shahane1
1Department of Internal Medicine, Rutgers Monmouth Medical Center, Long Branch, New Jersey, USA.
Insights
Coronary artery fistulas, rare heart abnormalities, can cause atrial flutter. Prompt diagnosis via multimodality imaging and transcatheter coil embolization offer effective treatment for this condition.
Area of Science:
- Cardiology
- Medical Imaging
- Interventional Cardiology
Background:
- Coronary artery fistulas are uncommon abnormal connections between coronary arteries and heart chambers or vessels.
- Large fistulas can lead to significant cardiac issues including chamber dilation, ischemia, heart failure, and arrhythmias.
Background:
Coronary artery fistulas are rare anomalous communications between a coronary artery and a cardiac chamber or great vessel. Large fistulas can cause chamber dilation, myocardial ischemia, heart failure, and arrhythmias.
Case Summary:
A 63-year-old man presented with palpitations, hypotension, and atrial flutter with rapid ventricular response requiring urgent cardioversion. Multimodality imaging with coronary computed tomography angiography and cardiac magnetic resonance revealed a large right coronary artery-to-superior vena cava fistula with right-sided chamber dilation. Cardiac catheterization confirmed the diagnosis, and the patient underwent successful transcatheter coil embolization.
Discussion:
Coronary artery fistulas may present with atrial arrhythmias due to chronic left-to-right shunting and atrial remodeling. This case highlights atrial flutter as an uncommon presentation and underscores the importance of multimodality imaging for diagnosis and procedural planning.
Take-Home Messages:
Coronary artery fistulas should be considered in patients with unexplained atrial arrhythmias and cardiac chamber enlargement. Early recognition enables definitive treatment with transcatheter closure.
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