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[Myocardial bridging as a cause of coronary insufficiency]
B Domínguez1, V Valderrama, R Arrocha
1Servicio de Cardiología, Complejo Hospitalario Dr. Arnulfo Arias M., Caja de Seguro Social.
Insights
Myocardial bridge (MB) can cause coronary insufficiency, especially with significant constriction (>75%) and left ventricular hypertrophy. Most cases are managed medically, with surgery reserved for a few.
Area of Science:
- Cardiology
- Cardiovascular Surgery
Context:
- Myocardial bridge (MB) is a congenital anomaly where a segment of the coronary artery travels through the heart muscle.
- Non-atherosclerotic coronary artery disease is an important differential diagnosis for ischemic symptoms.
Purpose:
- To investigate the clinical and angiographic characteristics of myocardial bridge (MB) in the absence of arteriosclerotic lesions.
- To determine the correlation between MB severity, left ventricular hypertrophy, and coronary insufficiency.
Summary:
- Two male patients with myocardial bridge (MB) in the right anterior descending coronary artery presented with angina pectoris and positive stress tests.
- Angiography revealed significant systolic constriction (80-90%) due to MB, with both patients exhibiting left ventricular hypertrophy.
- Authors conclude MB is a frequent cause of coronary insufficiency, with symptoms severity linked to constriction degree and LVH.
Impact:
- Highlights the role of MB as a cause of myocardial ischemia, particularly in cases without atherosclerosis.
- Suggests that significant systolic constriction (>75%) and left ventricular hypertrophy are key factors in symptomatic presentation.
- Emphasizes that medical management is often sufficient, with surgical intervention reserved for refractory cases.
Abstract:
The authors studied the clinical and angiographic findings in two patients who had a myocardial bridge (MB) in the right anterior descending coronary artery and did not have any arteriosclerotic lesions in the coronary arteries. The two patients were men, 57 and 58 years old. Both had a history of arterial hypertension (for 19 years and 6 months, respectively) and angina pectoris (for 7 years and 6 months, respectively). The resting EKG showed subepicardial ischemia in one and was normal in the other. The stress test was positive in both. Coronary artery angiography showed an MB in the right anterior descending coronary artery which caused a systolic constriction of 90% and 80%, 3 and 2 cm. long. Both patients had left ventricular hypertrophy. The authors conclude that MB is a frequent cause of coronary insufficiency and that the appearance of symptoms and their severity depends on the degree of systolic constriction, greater than 75%, and on the presence of left ventricular hypertrophy. The majority of patients are controlled with medical treatment and only a small number require surgical therapy.