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Case Reports
. 2005;32(1):50-2.

Increased myocardial ischemia during nitrate therapy: caused by multiple coronary artery-left ventricle fistulae?

Gulumser Heper  1 , Sedat Kose
Affiliations
Case Reports

Increased myocardial ischemia during nitrate therapy: caused by multiple coronary artery-left ventricle fistulae?

Gulumser Heper et al. Tex Heart Inst J. 2005.

Abstract

We present the case of a 54-year-old man who had crescendo angina during nitrate therapy. Selective coronary angiograms showed no atherosclerotic lesions, but did show plexuses of intramural vessels that connected the distal thirds of the left and right coronary systems with the left ventricle. The cause of our patient's increased myocardial ischemia during nitrate therapy may have been the coronary "steal" phenomenon.

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Figures

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Fig. 1 A) Angiogram (left lateral projection) shows the multiple fistulae originating from the left coronary system. B) Angiogram (right anterior oblique projection) shows the multiple fistulae originating from the right coronary system.
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Fig. 2 Myocardial perfusion images with Tc 99m sestamibi shows stress-induced reversible ischemia in the anterior and lateral walls.
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References

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