Md Anik Rahman

Calderdale and Huddersfield NHS Foundation Trust,
United Kingdom

Abstract Title: Right Coronary Artery-Superior Vena Cava Fistula with myocardial infarction due to steal syndrome: A rare case report.

Biography:

Dr. Md Anik Rahman, have completed MRCP(UK) and working as speciality registrar in the department of acute medicine with cardiology rotation in Calderdale and Huddersfield NHS Foundation Trust, UK.

Research Interest:

Coronary artery fistulas are anomalous connections between a coronary artery and a cardiac chamber or great vessel. They are rare abnormalities with a reported incidence of 0.13-0.18% of patients undergoing coronary angiography. CAFs rarely manifest as myocardial infarction in the absence of thrombosis within the fistula. A 59 years old Caucasian female presented to A&E with sudden severe squeezing central chest pain with radiation to left arm. She has background history of subarachnoid hemorrhage with clipped multiple aneurysm in different episodes. Examination did not show any significant findings like heart murmur. Initial Investigation revealed rising Troponin I from 222ng/l, 5 times normal(0/39ng/l) to 2125ng/l, 55 times normal, ECG showed sinus rhythm, RBBB and no ST changes. Bedside ECHO showed Hypokinetic inferior, inferoseptal and anteroseptal walls. Good systolic function elsewhere, visual LVEF 50-54%. Coronary CT angiogram revealed dilated tortuous vasculature along the course of nodal branch of right coronary artery communicating with the superior vena cava adjacent to cavo-atrial junction. No significant plaque disease. Coronary angiogram revealed normal coronary artery. Very large diameter RCA (Visually 10-12 mm), large AVM from the mid RCA to SVC with small aneurysm at the origin. Dobutamine stress ECHO revealed maximum negative exercise ECHO for inducible ischemia. Patient was unable to undergo CMR due to cerebral clips of unknown source. Initially she had been treated for NSTEMI with DAPT without anticoagulant due to residual cerebral aneurysm. She had been given surgical options for further treatment but she opted for conservative management. Most coronary artery fistula are silent and asymptomatic. In some rare cases symptoms of ischemic heart disease appear due to large shunt and steal of coronary circulation. The unique feature of this case includes diagnosis of myocardial infarction in the absence of thrombosis within fistula.