An 85 years old gentleman presented with retrosternal chest pain for six months. There was no heart murmur. Echocardiogram showed mild anterior hypokinesia; a persantin thallium scan showed partial reversible defect of the distal LAD territory. The patient underwent a coronary angiogram, which revealed a patent arteriovenous fistulae originated from a large first diagonal artery and draining into the pulmonary artery (Figures 1 and 2). This resulted in a distal LAD "steal" with subsequent myocardial ischaemia. The LV ventriculogram revealed a mild anterior hypokinesia.
Wai-Fat Lam, Coronary Artery Fistula Journal of the Hong Kong College of Cardiology 2001;9(1) https://doi.org/10.55503/2790-6744.1130