A Rapidly Progressing Native Coronary Artery to an Aneurysm Due to Distal Coronary to Ventricular Fistula- causing Anginal Chest Pain

Coronary artery fistula (CAF) is a rare congenital or acquired coronary anomaly. Although the majority of patients with CAF are asymptomatic, many of them present with angina pectoris, atypical chest pain, palpitation, fatigue, bacterial endocarditis, congestive heart failure, pericardial effusion and sudden cardiac death. We present a case of coronary artery fistula with recurrent episodes of chest pain that were thought to be resulting from coronary artery atherosclerosis. His left heart catheterization showed right coronary artery to left ventricular fistula that was not believed to be causing his chest discomfort as it was small and was left untreated. He continued to have these symptoms until fistula was repaired. Interestingly his fistula leads to a large coronary artery aneurysm over a short period of time. Our case is important with the fact that in the symptomatic patient with untreated fistula might get complicated and would lead to persistent symptoms.