A 66 year old woman was admitted to other hospital suffering from chest pain. After the treatment as non-ST elevation myocardial infarction, she was transferred to our clinic for angiographic evaluation. There was no evidence of reminiscent coronary artery-pulmonary artery fistula on transthoracic echocardiography. Coronary angiography showed significant stenosis at distal left anterior descending artery (LAD), its diagonal branch, and first obtus marginus. Two fistulas originating from LAD and RCA and join to pulmonary artery were seen in angiographic scenes. No ischemia was seen in RCA perfusion zone by myocardial scintigraphy. Because of the small lumen diameter of the distal LAD and mild shunt ratio (Qp/Qs:1.1) calculated with second echocardiographic examination after angiography, medical therapy was the final choice of treatment.