Three Vessel Coronary Cameral Fistulae Associated with New O
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Introduction
Coronary cameral fistulas are abnormal communications between a coronary artery and a heart chamber which are reported in less than 0.1% of patients undergoing diagnostic coronary angiography. The patients are usually asymptomatic so these fistulas are detected incidentally during coronary angiography most of the time. However, if fistulas are widespread, they may cause exertional angina due to coronary steal phenomenon concomitant with left ventricular volume overload and left atrial enlargement. All three major coronary arteries are even less frequently involved in fistula formation.

Case Report
A 68-year-old woman was admitted to cardiology clinic with complaints of exertional dyspnea and angina for two years and a new onset palpitation. Physical examination was unremarkable except for irregular beats. Standard 12-lead electrocardiogram revealed atrial fibrillation (AF) with a ventricular rate of 114 beat/minute and accompanying T wave abnormalities and minimal ST-depression on lateral derivations. The patient underwent transthoracic echocardiography for the investigation of dyspnea and AF etiology. TTE examination was normal except for diastolic dysfunction and mild to moderate enlargement of left atrium....

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3971846/
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