biostudies-literatureUnknown30(23)Ziotti SDV<h4>Background</h4>Coronary artery fistulas (CAFs) can lead to ischemia and angina in the absence of obstructive coronary artery disease. There is no evidence supporting a noninterventional approach to improve ischemia or alleviate symptoms for patients with refractory angina associated with CAFs.<h4>Case summary</h4>An 85-year-old woman presented with angina functional class 3 despite being on 3 antianginal medications. Myocardial scintigraphy showed reversible hypoperfusion in the left ventricle's lateral, inferolateral, and inferior walls. A coronary angiogram showed no obstructions; however, a CAF was found. Considering the patient's frailty and unsuitability for cardiac intervention, she was enrolled in a high-dose allopurinol protocol, which led to a significant improvement in symptoJACC. Case reports105010https://www.ebi.ac.uk/biostudies/studies/S-EPMC12462133biostudies-literatureMyocardial Perfusion and Angina Improvement Following Allopurinol Therapy in a Patient With Coronary Artery Fistula.PMC12462133Pereira TLVCesar LAMDourado LOCGowdak LHWMendonca CMMGrobe SFZiotti SDVRosal MSSerrano Junior CVAzevedo RPfalseMyocardial Perfusion and Angina Improvement Following Allopurinol Therapy in a Patient With Coronary Artery Fistula.<h4>Background</h4>Coronary artery fistulas (CAFs) can lead to ischemia and angina in the absence of obstructive coronary artery disease. There is no evidence supporting a noninterventional approach to improve ischemia or alleviate symptoms for patients with refractory angina associated with CAFs.<h4>Case summary</h4>An 85-year-old woman presented with angina functional class 3 despite being on 3 antianginal medications. Myocardial scintigraphy showed reversible hypoperfusion in the left ventricle's lateral, inferolateral, and inferior walls. A coronary angiogram showed no obstructions; however, a CAF was found. Considering the patient's frailty and unsuitability for cardiac intervention, she was enrolled in a high-dose allopurinol protocol, which led to a significant improvement in sympto2025-01-01T00:00:00Z2025 Aug2026-05-01T03:19:39.947Z2026-05-01T03:10:49.521ZS-EPMC124621334081684810.1016/j.jaccas.2025.105010