Coronary Artery-pulmonary Artery Fistula Originating from Three Major Coronary Branches Associated with Exertional Chest Pain and Tachycardia-dependent Left Bundle Branch Block
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概要
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A 49-year-old male was admitted to our hospital because of chest pain. The pain occurred simultaneously with tachycardia-dependent left bundle branch block (LBBB) during exercise-stress and atropine-stress electrocardiogram (ECG) and on 24-h ambulatory ECG monitoring. Myocardial perfusion and metabolic scintigraphy with T1-201 and I-123 BMIPP, respectively, showed no evidence of ischemia. Coronary arteriography revealed no atherosclerotic lesions, but did show a fistula between three major coronary arteries and the main pulmonary artery. The left-to-right shunt was undetectably small. Administration of diltiazem and metoprolol suppressed LBBB by attenuating the heart rate response to exercise, and reduced the chest pain. Therefore we presume that the exertional chest pain was not caused by myocardial ischemia but by the tachycardia-dependent LBBB. Coronary artery-pulmonary artery fistula is the most common type of coronary artery fistulae found incidentally in adulthood. Involvement of three major coronary branches is, however, rare. The case is discussed with a review of the literature.
著者
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Yoshimoto Nobuo
Third Department of Internal Medicine
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ITO Hiroyuki
Third Department of Internal Medicine, Showa University
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IIJIMA Tatsuyuki
Third Department of Internal Medicine,Sitama Medical Center,Saitama Medical School
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Tanaka Shugo
Third Department Of Internal Medicine Saitama Medical Center Saitama Medical School
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Segawa Kazuhiko
Third Department Of Internal Medicine Saitama Medical Center Saitama Medical School
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NAKAMURA Wako
Third Department of Internal Medicine, Saitama Medical Center, Saitama Medical School
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KAMIYAMA Tetsuo
Third Department of Internal Medicine, Saitama Medical Center, Saitama Medical School
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TAKAHASHI Kazunori
Third Department of Internal Medicine, Saitama Medical Center, Saitama Medical School
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IIJIMA Tatsuyuki
Third Department of Internal Medicine, Saitama Medical Center, Saitama Medical School
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