Combination of imaging modalities in a coronary artery fistula

A 35-year-old woman was referred for diagnostic evaluation of stitching pain under her left breast. The pain was not related to exercise. There were no cardiovascular risk factors. Physical examination, routine blood testing and chest X-ray were normal. Her ECG showed abnormal ST segments in III and aVF, and down-sloping ST segments with negative T waves in V₃ to V₄.