rare case of angina chest discomfort

IntroductionThe most common cause of angina chest pain is atherosclerotic coronary disease. In spite of this fact, many other causes are reported in the literature.Case reportA 63-year-old gentleman presented to cardiology clinic with complaint of chest discomfort and dyspnea with history of smoking.clinical examination revealed heart rate and blood pressure of 79 beats per minute and 130/80 mmHg. His heart sounds were normal and 12-lead ECG showed normal sinus rhythm with no significant ST-T changes.In order to assess ischemia, myocardial perfusion imaging (MPI) test was performed. The result showed significant reversible ischemia. Accordingly coronary angiography was performed. It confirmed the presence of two large fistulas between LAD and RCA, and pulmonary artery. Coronary arteries showed no stenosis in any vessel.DiscussionCoronary artery fistula (CAF) is communication between the coronary artery (CA) and heart chamber or vessel around the heart. The fistulas arise from RCA (in 52% of cases), LAD (30%) and LCX (18%). Most of them drained into the pulmonary artery (PA). As we reported our case is rare case that have bilateral fistulas (from RCA and LAD to PA).Most of the CAFs are small, without any symptoms, and are detectable only with or coronary angiography. However larger fistulas may cause symptoms, because of coronary steal phenomenon Management of the patients depend on the size, in large cases (regardless of detection of symptoms) and in moderate or small symptomatic cases, closure is recommended. In our case Qp/Qs is less than 1.5, so medical therapy was considered

rare case of angina chest discomfort Keywords:

chest pain , coronary artery disease , coronary artery fistulae.