AV fistula

[Esther]

I am a 49 year old white female who has been under the care of a cariologist for about 5 years.  There is marked CAD on my father's side of the family.  Due to chest pain I have had three sestamibi stress tests with resulting angios.  The first stress test revealed minimal fixed relative hypoperfusion of the anterior wall.  No associated ischemic changes.  A cardiac event in the distribution of the LAD cann be ruled out.  Angio - normal.  Second stress test - Findings suggestive of stress induced ischemia in the anterior wall.  Prior studies showed a mild fixed defect in this region - current findings are more makred and show a greater degree of reversibility.  An underlying subendocardial infarct cannot be exluded.  Angio - normal.  However, last year because of continued chest pain another angio was done which revealed an AV fistula involing diminutive right coronary artery -(a plexus of vessels occurring just distal to the origin of the vessel which fills another vessel which seems to empty into cardiac vein which empties into the right atrium. Echo revealed mobile anterior atrial septum noted in the subcostal view without demonstrable velocities across the septum. The possibility of a small ASD cann be completely exluded.  Last year I was also diagnosed with AF (although I go in and out of it).  Currently on Coumadin, BetaPace (160 mg bid), isordil and estrace.  Within the last couple of weeks I have been found to have VT and SVT.  What could be causing all of this.  I still continue to have chest pain radiating up into my neck, SOB and palpitations.  I have a cholesterol of 147.  I am at low risk - n smoking, not obese - etc.  The third sestamibi test was negative. The 2nd opinion doctor said that sometimes breast shadows will cause a positive result.  If this was a breast shadow - why were the first two positive and the third negative - ah the breast is still there...  Any input would be greatly appreciated.

[CCF CARDIO MD JMF]

It is difficult to put all this together.  You may have had a false positive stress test in the first place.

the AV fistula is generally of little consequence.  HOwever, i would pursue this issue of an ASD.  An ASD is often associated with arrhythmias.

I would also recommend avoiding caffeine.

Best of luck.