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Stolen from the coronaries: Left-to-Left shunts presenting as chest pain syndrome!
  1. Love Shah1,
  2. Deeksha Kundapur2 and
  3. Shravan Nosib3
  1. 1Internal Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
  2. 2Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
  3. 3Cardiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
  1. Correspondence to Dr Shravan Nosib; shravan.nosib{at}


We present the case of a 61-year-old woman with chest pain syndrome. Cardiac catheterisation did not reveal atherosclerotic coronary disease. However, a haemodynamically significant fistula connecting the left coronary artery to the left atrial appendage was found to be the culprit through a left-to-left shunting mechanism. In this report, we review the pathophysiology of coronary artery fistulas and the mechanism by which these fistulas may lead to ‘coronary steal syndrome’. Indications for interventional and surgical management are outlined. Ultimately, we suggest the consideration of coronary artery fistulas in the differential diagnosis of patients presenting with chest pain.

  • interventional cardiology
  • clinical diagnostic tests
  • radiology (diagnostics)
  • cardiothoracic surgery

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  • Contributors LS has written the case history and was involved in the management of the patient. DK was involved in literature review and manuscript preparation. SN has reviewed the manuscript, and edited the discussion.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.