ABSTRACT

Coronary arteriovenous fistula is a rare congenital anomaly that is seen in 0.1% to 0.2% of coronary angiograms. Clinically, patients with coronary fistula may present with palpitations or with symptoms of angina, heart failure, or bacterial endocarditis; or they may be totally asymptomatic. The clinical symptoms have attributed to a coronary steal phenomenon due to the shunting of blood via the low rezistance fistule. Nitrate therapy may increase the ischemia by means of increased leakage to the ventricle. We present the case of a 45-year-old woman who had crescendo angina during nitrate therapy.