ABSTRACT
Coronary artery fistulas (CAFs) are rare defects in the coronary circulation system that are usually diagnosed incidentally with cardiac imaging. Although the prognosis of coronary artery fistulas is highly variable, the complications to which they predispose patients are ultimately the determining factor. The authors describe a case of a 56-year-old male, a smoker, hospitalised for worsening dyspnoea on progressively smaller efforts, in the context of acute heart failure. During hospitalisation and imaging exams, a coronary-bronchial fistula was identified. LEARNING POINTS: CAFs are rare and may present with different anatomical configurations and clinical syndromes.Only 17% of CAFs reported draining into the pulmonary circulation.The optimal timing and role of CAFs intervention are not clearly defined.