Atypical Chest Pain: A Case Report.

Abstract

A 56-year-old female patient was referred to our institution for atypical chest pain and palpitations. Physical examination, resting ECG and transthoracic echocardiogram were unremarkable. Stress perfusion scintigraphy was positive for anterior and apical myocardial ischaemia. A subsequent coronary angiogram showed no signs of atherosclerotic coronary artery disease; however, it revealed a coronary arteriovenous fistula and multiple other fistulous connections between the proximal segment of the left coronary artery and the pulmonary artery trunk. We present a rare case of a symptomatic coronary fistula that was percutaneously closed using an Amplatzer Vascular Plug, which resulted in clinical improvement and late fistula occlusion. This case report underlines the importance of thinking beyond atherosclerosis in the evaluation of chest pain syndromes. Moreover, it describes some of the angiogram caveats in assessing the coronary fistula number and morphology, as well as the cardiac-catheter potential for multiple pathway coronary artery fistulae closer.Copy Right, IJAR, 2017,. All rights reserved. …………………………………………………………………………………………………….... Background:-Coronary arteriovenous fistula (CAVF) varies widely in its morphological appearance, clinical presentation and long-term outcome. Fistulae are congenital or acquired coronary artery abnormalities in which blood is shunted into a cardiac chamber or other vessels, bypassing the physiological myocardial capillary network. The CAVF location and dimensions determine their haemodynamic significance and clinical presentation, which can include dyspnoea, angina, congestive heart failure, pulmonary hypertension, arrhythmias or myocardial infarction. A majority of CAVF describe a simple trail, arising from the right coronary artery or the left anterior descending coronary artery, and lack clinical significance. However, larger fistulae may lead to coronary artery steal, with resultant ischaemia of the myocardium or other sequelae. Treatment is indicated for symptomatic patients and for those asymptomatic patients who are at risk for future fistula related complications. Although percutaneous CAVF closure is currently being used more frequently, a surgical approach is still considered the most suitable technique for larger, multiple fistulae or those associated with ventricular tachyarrhythmias or myocardial ischaemia.