A very rare case of myocardial ischaemia
- Isabel Durães Campos ,
- João Costa ,
- Pedro Azevedo and
- Jorge Marques
- Cardiology Department, Hospital de Braga, Braga, Portugal
- Correspondence to Dr Isabel Durães Campos; isabelcdcampos@gmail.com
Description
The authors present the case of a 74-year-old woman with a previous history of hypercholesterolaemia, hypertension and atypical chest discomfort, who was admitted to the emergency department with severe retrosternal pain radiating to her left shoulder and dyspnoea of 2 hours of onset. On admission, physical examination was normal, with no signs of cardiac failure. The ECG showed a sinus rhythm with no pathological Q wave, abnormal ST segment or T wave changes. Laboratory blood tests showed elevated cardiac biomarkers (13 ng/mL for troponin and 42 IU/L for creatine kinase myocardial band). Transthoracic echocardiography presented normal wall motion with a left ventricular (LV) ejection fraction of 59% and mild LV hypertrophy. Due to clinical suspicion of coronary pathology, the patient was submitted to invasive coronary angiogram, which showed multiple microfistulas from the left coronary artery draining into the LV, with no significant atherosclerotic stenosis (figure 1A,B,video 1). Considering the numerous fistulas and the clinical context, the symptoms were thought to be caused by a coronary steal phenomenon. The patient was discharged for outpatient investigation with a follow-up coronary CT angiogram, that confirmed this rare congenital condition and excluded other cardiac anomalies. The patient was treated conservatively and at the follow-up, 1 year after the arteriography, the patient was asymptomatic.
Coronary angiography in the late phase of contrast injection showing multiple microfistulas from the left coronary artery draining into the left ventricle with no significant atherosclerotic stenosis. (A) Left coronary artery in a left anterior oblique cranial projection. (B) Right coronary artery in a left anterior oblique projection.
Acknowledgments
The authors thank Dr Regina Barros Pereira for her extremely valuable support during the preparation of this manuscript.
Footnotes
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Contributors IDC and JM were responsible for medical data acquisition. IDC wrote the manuscript. PA was the doctor responsible for the case orientation. JC, PA and JM revised the manuscript for important intellectual content. All authors gave the final approval of the version to be published.
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Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
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Competing interests None declared.
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Patient consent for publication Obtained.
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Provenance and peer review Not commissioned; externally peer reviewed.
- © BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.
References
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