Background: A 57-year-old man presented with dyspnea and presyncope on exertion. He had previously been diagnosed with hypertension, hypercholesterolemia and atrial fibrillation. A soft (grade II/VI), dynamic continuous murmur was noted in the mid precordium.
Investigations: Electrocardiography, stress echocardiography and coronary angiography.
Diagnosis: Right coronary artery to coronary sinus fistula with coronary steal, exertional ischemia and ventricular arrhythmia.
Management: Coil embolization of coronary left ventricular fistula.