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Left coronary artery-left ventricle fistula with right coronary artery spasm
1Department of Cardiology, Saitama Cardiovascular and Respiratory Center, Japan. komu@jikei.ac.jp
Insights
A 72-year-old woman experienced chest pain, initially suspected to be linked to a coronary artery-left ventricle fistula or spasm. However, her symptoms improved with a minor tranquilizer, suggesting the pain was not cardiac-related.
Area of Science:
- Cardiology
- Vascular Medicine
Background:
- Chest pain evaluation in elderly patients.
- Coronary artery anomalies and vasospasm.
Observation:
- A 72-year-old woman presented with chest pain.
- Coronary angiography revealed a left coronary artery-left ventricle fistula.
- Acetylcholine testing induced right coronary artery vasoconstriction, but not left.
Findings:
- Pharmacological treatment for coronary vasospasm (isosorbide dinitrate, diltiazem, nicorandil) was ineffective.
- Beta-blockers were contraindicated due to coronary spasm.
- Chest pain resolved with a minor tranquilizer, suggesting a non-cardiac origin.
Implications:
- This case highlights the importance of considering non-cardiac causes of chest pain, even with identified coronary anomalies.
- Differentiating cardiac from non-cardiac chest pain is crucial for appropriate management.
- The diagnostic challenge posed by coronary artery fistulas and vasospasm.
Abstract:
A 72-year-old woman was admitted to our hospital for evaluation of chest pain. Coronary angiography showed a left coronary artery-left ventricle fistula. An acetylcholine provocation test induced vasoconstriction of the right but not the left coronary artery. Her chest pain was not relieved by combined therapy with isosorbide dinitrate, diltiazem and nicorandil. Because of the coronary spasm, beta-blockers could not be used. However, her chest pain was relieved after the administration of a minor tranquilizer. Thus, the patient's chest pain was unlikely to be associated with either the fistula or the coronary spasm.