Left coronary artery-left ventricle fistula with right coronary artery spasm.
A 72-year-old woman was admitted to our hospital for evaluation of chest pain. Coronary angiography showed a left coronary artery-left ventricle fistula. An acetylcholine provocation test induced vasoconstriction of the right but not the left coronary artery. Her chest pain was not relieved by combined therapy with isosorbide dinitrate, diltiazem and nicorandil. Because of the coronary spasm, beta-blockers could not be used. However, her chest pain was relieved after the administration of a minor tranquilizer. Thus, the patient's chest pain was unlikely to be associated with either the fistula or the coronary spasm.
Department of Cardiology, Saitama Cardiovascular and Respiratory Center, Japan. komu@jikei.ac.jp
K
K
Komukai
M
M
Muto
K
K
Imai
K
K
Hashimoto
K
K
Iwano
J
J
Mogi
T
T
Shibata
T
T
Horie
S
S
Mochizuki
D000109:Acetylcholine; D000368:Aged; D000525:Alprazolam / Q000627:therapeutic use; D000787:Angina Pectoris / Q000175:diagnosis; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D009202:Cardiomyopathies / Q000150:complications* / Q000473:pathology; D002637:Chest Pain / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D003327:Coronary Disease / Q000150:complications* / Q000473:pathology; D003329:Coronary Vasospasm / Q000000981:diagnostic imaging / Q000209:etiology*; D003937:Diagnosis, Differential; D005260:Female; D005402:Fistula / Q000150:complications* / Q000473:pathology; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D011859:Radiography; D014662:Vasoconstrictor Agents
D014151:Anti-Anxiety Agents; D014662:Vasoconstrictor Agents; D000109:Acetylcholine; D000525:Alprazolam