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Published on: November 24, 2014
Coronary myocardial bridge: an innocent bystander?
Robert F Bonvini1, Jasmina Alibegovic, Xavier Perret
1Cardiology Center, University Hospital of Geneva, 24 Rue Micheli du Crest, 1211 Geneva, Switzerland. robert.bonvini@hcuge.ch
Insights
Myocardial bridges (MB) are congenital coronary artery abnormalities causing systolic compression. Symptomatic cases can be effectively managed with medications or coronary stenting, especially when angina is present without other coronary disease.
Area of Science:
- Cardiology
- Congenital Heart Abnormalities
Background:
- Myocardial bridge (MB) is a congenital anomaly where a segment of a coronary artery tunnels through heart muscle.
- It causes systolic compression and diastolic diameter reduction, with an incidence of 0.5%-5.5%.
Observation:
- The left anterior descending artery is most commonly affected, followed by diagonal branches, right coronary artery, and left circumflex.
- While generally benign, factors like high heart rate can precipitate symptoms such as angina.
Findings:
- Two cases of symptomatic myocardial bridge successfully treated with negative inotropic drugs and coronary stenting are presented.
- This highlights effective medical and interventional strategies for managing MB.
Implications:
- Myocardial bridge should be considered in differential diagnoses for typical angina symptoms without significant coronary artery disease.
- Correct diagnosis and management, including medical therapy and stenting, are crucial for symptomatic patients.
Abstract:
Myocardial bridge (MB) or tunneled coronary artery is an inborn abnormality, which implicates a systolic vessel compression with a persistent mid-late diastolic diameter reduction. Myocardial bridges are often observed during coronary angiography with an incidence of 0.5%-5.5%. The most involved coronary artery is the left anterior descending artery followed by the diagonal branches, the right coronary artery, and the left circumflex. The overall long-term prognosis is generally benign. However, several risk or precipitating factors (e.g., high heart rate, left ventricular hypertrophy, decreased peripheral vascular resistance) may trigger symptoms (most frequently angina). Herein, we describe two cases of symptomatic myocardial bridge, where medical treatment (i.e., inotropic negative drug) and coronary stenting were successfully utilized to treat this pathology. We also focus on the clinical presentation, and the diagnostic and therapeutic modalities to correctly manage this frequently observed congenital coronary abnormality, underlining the fact that in cases of typical angina symptoms without any significant coronary artery disease, MB should be considered as a possible differential diagnosis.
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