A Rare Association: Apical Hypertrophic Cardiomyopathy with Multiple Coronary Artery-Left Ventricular Fistulae

A 59-year-old woman was referred for evaluation of chest pain and she was diagnosed of acute coronary syndrome. Coronary arteriography showed a severe stenosis of left anterior descending artery but also the presence of multiple coronary artery-left ventricle micro-fistulae. Echocardiographic findings were consistent with apical hypertrophic cardiomyopathy and the fistulae were also patent by colour Doppler echocardiography. Little is known about clinical features of micro-fistulae arising from both coronary arteries and emptying into left ventricle, especially when they are associated with apical hypertrophic cardiomyopathy.