Multiple coronary-cameral fistulae causing angina pectoris.

A 55-year-old man came to our hospital with exertional chest pain, dyspnea, and fatigue that had lasted 3 months. On physical examination, his blood pressure was 130/70 mmHg, and his heart rate was 85 beats/min. Electrocardiography showed sinus rhythm and no specific changes in the ST segment or the T wave. Echocardiography revealed ventricles of normal size and function. Coronary angiography revealed multiple fistulae that arose from all 3 major coronary arteries and drained exclusively into the left ventricle (Figs. 1 and 2). The coronary arteries were free of atherosclerotic disease. We performed repeat echocardiography, focusing on the fistulae, which indeed drained into the left ventricle (Fig. 3). The patient was discharged from the hospital with instructions to take 100 mg of metoprolol daily. He has experienced no anginal symptoms for 1 year. Images in Cardiovascular Medicine