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Daughter, you broke my heart: accidental thrombosis at a muscular bridge

Fernando Leon1, Hector Salazar, Wendel Moreira

  • 1Department of Cardiology, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas 77030, USA.

Texas Heart Institute Journal
|October 17, 2006
PubMed

Insights

Extreme exertion and anxiety triggered acute myocardial infarction in a trained runner with a myocardial bridge. This case suggests myocardial bridges can cause heart attacks via clot formation under specific circumstances.

Area of Science:

  • Cardiology
  • Exercise Physiology

Background:

  • Myocardial bridges are congenital anomalies where a segment of coronary artery tunneled through heart muscle.
  • While often benign, they can be associated with myocardial ischemia, particularly during increased cardiac workload.

Observation:

  • A 59-year-old trained runner experienced acute myocardial infarction (heart attack) with exertional angina.
  • The event occurred after extreme physical exertion coupled with severe anxiety.
  • Coronary angiography identified a myocardial bridge in the mid-left anterior descending artery.

Findings:

  • An occlusive thrombus (blood clot) was found at the proximal end of the myocardial bridge.
  • This suggests a potential causal link between the myocardial bridge, exertion, anxiety, and clot formation leading to infarction.

Implications:

  • This case highlights that myocardial bridges, especially under extreme physiological stress, can precipitate myocardial infarction.
  • It underscores the importance of considering anatomical variations like myocardial bridges in the differential diagnosis of exertional myocardial infarction.
  • Further research may elucidate the precise mechanisms linking stress, myocardial bridges, and thrombogenesis.

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