Stress-induced ischemia caused by conus branch of right coronary to right atrial coronary cameral fistula during treadmill test

Abstract

A 28-year-old apparently healthy young male working in Border Security Force referred to our institute for annual master health checkup. The routine biochemical tests, 12-lead electrocardiogram (EKG), chest X-ray, and echo were normal. His exercise ECG was remarkable for significant horizontal ST depression in lead I, AVL, V4–V6 during treadmill test at 15 METs. He had usual breathlessness during exercise. Coronary angiogram revealed conus branch of right coronary artery to right atrial coronary cameral fistula draining into right atrium which may be an unusual reason for inducible ischemia at high-intensity exercise as the other coronary arteries were normal. He is now under regular follow-up for need–based, catheter-based intervention in the future because of asymptomatic presentation and small size fistula. A period of 12-month follow-up was uneventful.