Giant aneurysm of the right coronary artery presenting with a systolic murmur.(Brief Article)

A 75 year old man presented with a two year history of increasing exertional dyspnoea and discomfort in his left arm, both relieved by rest. There was no relevant past medical history, and no history of trauma to the chest. Physical examination revealed a harsh continuous systolic murmur continuing into early diastole at the lower left sternal edge. The murmur did not radiate to the apex, and was felt by the examining clinician to be unusual, and possibly related to a coronary fistula.

Transthoracic echocardiography showed normal left ventricular function with mild mitral regurgitation. No other abnormality was seen. Exercise treadmill test revealed downsloping ST …