Laboratory of Rapid Cardiac Diagnostics, Department of Cardiology, Medical University of Lodz, Poland.
Cardiol J. 2010;17(3):299-302.
A 77-year-old woman was referred to our Department of Cardiology because of exacerbation of chest pain and decreased exercise intolerance. No acute ischemic electrocardiography changes were seen in an electrocardiogram recorded on admission. An exercise test was terminated at 7 METS because of shortness of breath without evidence of ischemia. The patient was referred for a coronary angiography which showed a coronary artery fistula filling from the left anterior descending (LAD) artery and resulting in a large inflow to the main pulmonary artery, without other significant coronary lesions. Transthoracic echocardiography showed a coronary artery fistula draining to the main pulmonary artery. Coronary steal was suspected and coronary flow reserve was evaluated in LAD, showing normal values for age. Due to the overall clinical picture, with the predominance of heart failure symptoms and the lack of significant abnormalities of flow reserve in LAD, medical therapy was selected. The patient remained free from cardiovascular symptoms at 6-month follow-up.
一位 77 岁女性因胸痛加剧和运动耐量下降被转至心内科。入院时记录的心电图未见急性缺血性改变。由于呼吸困难，运动试验在 7 代谢当量（METs）时终止，无缺血证据。患者被转介进行冠状动脉造影，显示冠状动脉瘘从左前降支（LAD）充盈，并导致主肺动脉大量流入，无其他明显冠状动脉病变。经胸超声心动图显示冠状动脉瘘引流至主肺动脉。怀疑存在冠状动脉窃血，并对 LAD 进行冠状动脉血流储备评估，显示年龄相关的正常数值。由于整体临床表现，以心力衰竭症状为主，LAD 血流储备无明显异常，选择了药物治疗。患者在 6 个月随访时仍无心血管症状。
