Academy of Medical Sciences of I.R. Iran Archives of Iranian Medicine 1029-2977 23 10 2020 10 01 Microfistulas Causing Diverse Regional Ischemia: Consecutive Inferior and Lateral ST-Elevation Myocardial Infarction 704 706 10.34172/aim.2020.89 EN Tufan Çınar Yavuz Karabağ İbrahim Rencuzogullari Metin Cağdaş Journal Article 10.34172/aim.2020.89 2018 09 30 2019 05 14 Coronary artery fistulas (CAFs) are described as abnormal communications between a coronary artery and cardiac chambers, or other vascular structures. The two types of CAFs are defined as type I (singular fistula) and type II (microfistulas). Even though various electrocardiographic changes have been previously described in CAF patients, coronary-artery microfistulas causing ST-segment elevation in diverse locations have not been reported. We describe a case report of an adult patient who presented with acute inferior myocardial infarction due to coronary-artery microfistulas. During the hospital stay, the patient re-experienced chest pain, and control electrocardiography revealed ST-segment elevation in the I and AVL leads along with reciprocal ST-segment depression in the inferior precordial leads. Although CAFs are clinically rare, they can have important clinical consequences. Microfistulas should be kept in mind as a cause of ST elevation myocardial infarction in some patients.