Coronary artery fistula and mid-cavitary obstructive hypertrophic cardiomyopathy: a rare association

We report a case of a 60-year-old man with a history of angina on exertion (New York Heart Association Class II) who was found to have mid-cavitary obstructive hypertrophic cardiomyopathy on two-dimensional echocardiography and whose coronary angiogram showed right coronary artery-left ventricular fistula, with no significant coronary atherosclerosis suggestive of ischaemic heart disease. The patient was started on beta-blocker therapy, and on follow-up his angina improved. The patient had a benign course and did not have any progressive heart failure or acute coronary syndrome on follow-up. This case report highlights a rare association of mid-cavitary obstructive hypertrophic cardiomyopathy with coronary artery fistula.