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We report the case of a 74 year-old woman admitted for coronary angiogram because of widespread electrocardiographic repolarization abnormalities. Her past medical history was mainly paroxystic atrial fibrillation. Her cardiovascular risk factors were age and smoking. Echocardiography revealed apical left ventricular hypertrophy. Physical examination was normal. Surprisingly, the coronary angiogram revealed multiple fistulae from both left and right coronary system (Fig. 1A, B). These fistulae were so deve-

cardiology journal

Multiple coronary-left ventricular fistulae associated with apical hypertrophic cardiomyopathy: Coronary angiogram compared to coronary scan and cardiac magnetic resonance scan