A 68-year-old female came to our hospital with exertional chest pain, fatigue, and breathlessness on exertion since the last 3–4 months. On physical examination, her blood pressure was 150/70 mmHg, and her heart rate was 96 beats/min. Electrocardiography showed sinus rhythm and no specific changes in the ST segment or the T wave. Echocardiography revealed ventricles of normal size and function with no regional wall motion abnormality. Coronary angiography revealed multiple fistulae that arose from all threemajor coronary arteries (left anterior descending, left circumflex, andright coronary arteries) thatdrained into the left ventricle near the apex (Figure 1, 2, 3 & Movie 1, 2, 3). The coronary arteries were free of any atherosclerotic disease. The patient was discharged from the hospital on optimal medical management including beta blockers and a antihypertensive with instructions for diabetescontrol.
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