[Myocardial bridging and coronary spasm on effort]

Area of Science:

• Cardiology
• Vascular Biology

Background:

• Myocardial bridging is frequently identified during coronary angiography but seldom implicated as a cause of acute coronary syndrome.
• Acute coronary syndrome (ACS) typically results from atherothrombotic events.

Observation:

• A 45-year-old active male with no cardiovascular risk factors presented with ACS.
• Initial coronary angiography revealed myocardial bridging on the anterior interventricular artery, insufficient to explain the ACS.
• A second angiogram with endocoronary echography excluded atheroma; a methergin test induced diffuse coronary spasm.

Findings:

• The case demonstrates a rare instance of acute coronary syndrome precipitated by the combined presence of myocardial bridging and diffuse coronary vasospasm.
• Endocoronary echography proved valuable in excluding atheroma and assessing coronary artery dynamics.

Implications:

• This report underscores the importance of considering coronary vasospasm in patients with myocardial bridging presenting with unexplained acute coronary syndrome.
• The findings suggest that the interplay between structural anomalies (myocardial bridging) and functional abnormalities (coronary spasm) can precipitate acute coronary events.
• Further research into the clinical, therapeutic, and prognostic characteristics of this rare association is warranted.