“…While the most frequent symptom is exercise dyspnea, patients may also present with fatigue, atrial arrhythmias, pulmonary hypertension, heart failure, endocarditis, and even sudden cardiac death. On the other hand, angina generally occurs if there is a coexisting condition such as atherosclerotic heart disease, hypertrophic cardiomyopathy, or aortic stenosis (3,7). The hemodynamic significance of coronary fistulas are determined by the flow rate across the fistula itself or the heart chambers they originate from and drain into.…”