PT  - JOURNAL ARTICLE
AU  - Love Shah
AU  - Deeksha Kundapur
AU  - Shravan Nosib
TI  - Stolen from the coronaries: Left-to-Left shunts presenting as chest pain syndrome!
AID  - 10.1136/bcr-2021-242425
DP  - 2021 Mar 01
TA  - BMJ Case Reports
PG  - e242425
VI  - 14
IP  - 3
4099  - http://casereports.bmj.com/content/14/3/e242425.short
4100  - http://casereports.bmj.com/content/14/3/e242425.full
SO  - BMJ Case Reports2021 Mar 01; 14
AB  - 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.