Multiple Coronary Artery–Left Ventricle Microfistulae and Spongy Myocardium The Eagerly Awaited Link?

A 54-year-old female from Brazil with a 2-month history of anterior chest pain episodes was referred to our hospital. Before admission she underwent an ECG stress test that showed significant ST-segment depression in leads V4–V6 together with anginal symptoms. The patient had a family history of sudden cardiac death (2 sisters died at 36 and 54 years of age) and a past history of hypertension. She had never suffered from syncope or palpitations. Biochemical blood parameters and urinalysis were in the normal range. Twelve-lead ECG presented ST-T nonspecific abnormalities (Figure 1) and chest x-ray was normal but showed a mild increase in the second right arch (Figure 2). Figure 1. Standard ECG shows sinus rhythm, normal QRS duration, and nonspecific repolarization changes. Figure 2. Posteroanterior view chest radiography. It shows mild increase in the right second arch. Echocardiogram revealed thickened left ventricular walls, mostly in the lateral and inferior midventricular and distal segments, …