Coronary arterial fistulas are rare communications between vessels or chambers of the heart. Although cardiac symptoms associated with fistulas are well described. fistulas are seldom considered in the differential diagnosis of acute myocardial ischemia. We describe the case of a 64-year-old man who presented with left shoulder pain. https://www.chiggate.com/five-finger-death-punch-a-decade-of-destruction-vol-1-cd-supply/