Multiple Coronary Artery Fistulas and 3-Vessel Disease in an Elderly Patient With Unstable Angina.

BACKGROUND

Coronary artery fistula (CAF) is an atypical vascular communication that drains into a cardiac chamber or vessel and is usually unrelated to atherosclerotic coronary artery disease (CAD).

CASE SUMMARY: An elderly patient with high-risk unstable angina underwent coronary angiography, which revealed 3-vessel CAD and multiple CAFs. Medical treatment was elected.

DISCUSSION: Multiple CAFs, especially a large right CAF draining into the left ventricle in the context of significant 3-vessel CAD in an elderly patient, represent a rare finding with an unusual presentation of unstable angina. This case highlights the diagnostic challenges and management considerations in such complex scenarios, enriching the limited available literature.

TAKE-HOME MESSAGE: The co-occurrence of multiple CAFs with CAD creates a unique management challenge, requiring a tailored approach that extends beyond the current limited literature.