RT Journal Article SR Electronic T1 Stolen from the coronaries: Left-to-Left shunts presenting as chest pain syndrome! JF BMJ Case Reports JO BMJ Case Reports FD BMJ Publishing Group Ltd SP e242425 DO 10.1136/bcr-2021-242425 VO 14 IS 3 A1 Love Shah A1 Deeksha Kundapur A1 Shravan Nosib YR 2021 UL http://casereports.bmj.com/content/14/3/e242425.abstract 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.