Arteriovenous (AV) fistulae are well known to cause high output cardiac failure. AV fistulae from cardiac catheterization are as rare as 0.01% in the transfemoral approach. We describe here what we believe is the first reported case of high output cardiac failure from an AV fistula due to percutaneous transluminal coronary angioplasty (PTCA). The patient had reversal of the congestive heart failure with surgical correction of the fistula.