Case presentation:
An 80-year-old male with a history of diabetes-mellitus presented with worsening dyspnea and chest pain. The nuclear stress test was positive for ischemia in the basal inferoseptal/basal inferior, and septal walls. Coronary angiogram showed mild coronary artery disease, however noted coronary-cameral fistulas (CCF) arising from both the right coronary artery (RCA) and left anterior descending artery (LAD) (Figure AB. Video 1& 2). We conclude his symptoms are related to the significant coronary to left ventricle (LV) shunt due to these dual coronary fistulas. The patient was deemed not suitable for closure of the fistulae due to small/multiple fistulae and therefore was managed conservatively.