LEFT CORONARY-ARTERY LEFT-VENTRICLE FISTULA WITH RIGHT CORONARY-ARTERY SPASM

A 72-year-old woman was admitted to our hospital for evaluation of che st pain. Coronary angiography showed a left coronary artery-left ventr icle fistula. An acetylcholine provocation test induced vasoconstricti on of the right but not the left coronary artery. Her chest pain was n ot relieved by combined therapy with isosorbide dinitrate, diltiazem a nd nicorandil. Because of the coronary spasm, beta-blockers could not be used. However, her chest pain was relieved after the administration of a minor tranquilizer. Thus, the patient's chest pain was unlikely to be associated with either the fistula or the coronary spasm.