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Unusual presentation of right coronary artery fistula
  1. Ahmed MSEK Abdelaty1,2,
  2. Anvesha Singh1,
  3. Gerry P McCann1
  1. 1University Hospitals of Leicester NHS Trust, Leicester, UK
  2. 2Suez Canal University, Ismailia, Egypt
  1. Correspondence to Dr Ahmed MSEK Abdelaty, amsek1{at}

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A female aged 70 years, with no previous comorbidities, was referred with suspected heart failure due to mild exertional dyspnoea, mildly elevated brain-natriuretic peptide (BNP) (139 ng/L) and inferolateral T-inversion on ECG. A transthoracic echocardiogram (TTE) showed a moderate global pericardial effusion, mild left ventricular hypertrophy (LVH), moderate aortic stenosis (AS) and preserved systolic function. Serial TTE’s showed a resolving pericardial effusion, moderate left ventricular hypertrophy (LVH) and bi-atrial dilatation, following which cardiac magnetic resonance imaging (CMR) was requested to exclude infiltrative cardiomyopathy. An angiogram was also requested due to suspicion of moderate-to-severe AS, as a work-up for future valve replacement. CMR showed a severely …

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