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[Myocardial bridge - cause of cardiac phase-dependent coronary stenosis (author's transl)]
Insights
A patient with hypertrophic obstructive cardiomyopathy experienced coronary artery constriction during systole. Surgical intervention for muscle bridges may benefit symptomatic individuals with severe coronary obstruction.
Area of Science:
- Cardiology
- Cardiovascular Surgery
Background:
- Hypertrophic obstructive cardiomyopathy (HOCM) can lead to dynamic coronary obstruction.
- Exercise-induced anginal pain is a common symptom requiring thorough investigation.
Observation:
- A 41-year-old male presented with anginal pain and a positive exercise electrocardiogram.
- Hemodynamic and angiographic studies revealed mild HOCM and a unique systolic-phase stenosis in the proximal left anterior descending artery.
Findings:
- The coronary artery constriction was transient, resolving after the systolic phase.
- The dynamic nature of the stenosis suggests a functional component beyond fixed atherosclerotic disease.
Implications:
- Consider surgical dissection of myocardial bridges in symptomatic patients with severe, dynamic coronary obstruction.
- This case highlights the importance of evaluating coronary artery dynamics in obstructive cardiomyopathy.
Abstract:
A 41 year-old man presented with anginal pain and a positive exercise electrocardiogram. Hemodynamic and angiographic evaluation disclosed mild hypertrophic obstructive cardiomyopathy and a conic stenosis of the proximal left anterior descending artery confined to the systolic phase of the heart action. The degree of constriction of the coronary artery was no longer evident. Pathophysiologic consequences suggest that surgical dissection of muscle bridges should be considered in symptomatic patients with severe coronary obstruction.