Secondary demonstrated myocardial ischemia due to multiple coronary fistulae draining into the left ventricle

There are few cases of demonstrated ischemia due to the presence of multipl e coronary fistulae. We report a case of multiple coronary fistulae from le ft anterior descending, circumflex and right coronary arteries draining int o the left ventricle, which were responsible for myocardial ischemia demons trated with thallium stress test. They were diagnosed by coronary angiograp hy, and their etiology seems to be congenital. The final control of symptom s was achieved with beta-blockers, and not with nitrates, which speaks for a "steal phenomenon" as the cause of ischemia.