'A snake and a crescent moon in a coronary angiogram

Description 

A  coronary artery fistula   (CA F) is a direct connection between a coronary artery and any one of the cardiac chambers, the coronary sinus or superior vena cava, or a pulmonary artery or pulmonary vein close to the heart. CAF accounts for 48.7% of all congenital coronary anomalies.1 The most common drainage sites in a decreasing frequency are the right ventricle (41%), right atrium (26%), pulmonary artery (17%), coronary sinus (7%), left atrium (5%), left ventricle (3%) and superior vena cava (1%).2 Further occurrence of this CAF along with the presence of aortic sinus to pulmonary artery fistula is very rare.

We present a case of a 53-year-old, hypertensive man who had presented with a first episode of chest pain of 8 hours' duration. At presentation in the emergency department, his heart rate was 90/min and blood pressure measured 158/85 mm Hg. His cardiac and chest examinations were...

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