Cardiopulmonary exercise test findings in a patient with a coronary fistula

Javier E. Mosquera-Manrique, Programa de Medicina del Deporte, Universidad El Bosque; Centro de Prevención Cardiovascular, Fundación Clínica Shaio; Bogotá, Colombia
Juan M. Sarmiento, Centro de Prevención Cardiovascular, Fundación Clínica Shaio, Bogotá, Colombia
Jimena A. Sierra-Cabrera, Centro de Prevención Cardiovascular, Fundación Clínica Shaio; Fundación Universitaria Juan N. Corpas. Bogotá, Colombia

In medical practice, it is common to encounter challenges in the diagnosis of patients. The case report gives a detailed description of the clinical history of a young adult female patient who presented the cardinal warning signs of chest pain and longstanding dyspnea on exertion and was ultimately diagnosed with a rare presentation of a coronary fistula. The patient had previously undergone multiple cardiovascular tests described in the medical literature as a non-invasive means for identifying this disorder (conventional stress test, transthoracic echocardiogram, and myocardial perfusion), but with no definitive diagnosis. Finally, she underwent coronary arteriography, the gold standard procedure, due to her abnormal results on the cardiopulmonary exercise test (CPET), which was ordered due to dyspnea of unclear etiology.

Keywords: Chest pain. Ergospirometry. Coronary fistula.