A 46-year-old Greek female (weight 60 Kg, height 1.65 cm) with symptomatic stable angina and myocardial ischemia documented at 99mTc-MIBI SPECT scintigraphy admitted to the hospital complaining of retrosternal chest pain appeared at rest one hour before admission. The patient was also known to suffer from hypertension and hypercholesterolemia and had a strong family history of ischemic heart disease as her father and her brother had a myocardial infarction at the age of 55 and 45 respectively. She was taking aspirin, b-blocker and statin prior to this admission. Clinical examination demonstrated normal heart and chest sounds, an elevated blood pressure 155/90 mmHg and a heart rate 85 beats per minute. The jugular venous pressure was not elevated while the electrocardiogram revealed sinus rhythm with ST depression in the precordial leads V2 to V6. There was no evidence of heart failure. The patients was put on fondaparinux, agrastat, clopidogrel 300 mg, nitrates and her aspirin b-blocker and statin were continued. She underwent a coronary arteriogram next day which revealed a CAF from LAD to the main pulmonary artery, a blocked right coronary artery and significant stenoses on the other vessels. The patient was admitted for coronary artery bypass surgery and fistula closure with multiple stitches. After the operation the patient was asymptomatic and a nuclear scan, performed 6 months later, showed a normal myocardial perfusion.