Primary aldosteronism and coronary-pulmonary artery fistula: coincidence or causal link? A case report and literature review

Background: Primary aldosteronism (PA) is the most frequent form of potentially reversible hypertension and coronary-pulmonary fistulas are increasingly recognized during routine coronary angiography or multidetector computed tomography for analysis of chest pain in hypertensive patients. Aldosterone hypersecretion has been associated with endothelial proliferation and pathological remodeling of the heart and arteries, though coronary artery fistulas have never been reported in patients with PA. Case presentation: The authors report the first case of PA with dilated cardiomyopathy unusually associated with electrocardiographic changes after normalization of hypokalemia and with the finding of a coronary-pulmonary fistula during coronary angiography. The clinical presentation and our diagnosis and treatment decision-making in the COVID-19 era are discussed below. Conclusions: Our case suggests a potential link between hypertensive patients with coronary artery fistulas and PA.