Myocardial bridging causing ischemia and recurrent chest pain: a case report
1Cardiology Department, Zagazig Faculty of Medicine, Zagazig, Egypt. mhmdabdou232@yahoo.com.
Insights
Myocardial bridging, a coronary artery anomaly, can cause chest pain and ST-segment elevation during exercise. This case highlights its potential to trigger ischemic events, emphasizing the need for careful management.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Clinical Case Reports
Background:
- Myocardial bridging involves coronary arteries running within the heart muscle.
- While often benign, it can lead to myocardial ischemia, infarction, and sudden cardiac death.
- This case presents a patient with recurrent chest pain and exercise-induced ST-segment elevation due to myocardial bridging.
Purpose of the Study:
- To report a case of myocardial bridging presenting with recurrent chest pain and transient ST-segment elevation.
- To discuss the potential link between myocardial bridging and coronary vasospasm.
- To illustrate diagnostic and management strategies for complicated myocardial bridging.
Main Methods:
- A 40-year-old male with recurrent chest pain underwent an exercise treadmill test.
- The test revealed chest pain and significant ST-segment elevation.
- Coronary angiography confirmed myocardial bridging in the mid-left anterior descending artery.
Main Results:
- The patient experienced chest pain and ST-segment elevation during exercise, persisting into recovery.
- Coronary angiography identified myocardial bridging.
- The patient recovered well with medical management and remained asymptomatic at one-year follow-up.
Conclusions:
- Myocardial bridging may predispose individuals to coronary vasospasm.
- This vasospasm can result in significant ischemic complications.
- Prompt diagnosis and appropriate medical treatment are crucial for managing symptomatic myocardial bridging.
Background:
Myocardial bridging is present when a segment of a major epicardial coronary artery runs intramurally through the myocardium. It usually has a benign prognosis, but in some cases myocardial ischemia, infarction and sudden cardiac death have been reported. We are here reporting a case of myocardial bridging which was complicated with recurrent chest pain and transient ST-segment elevation during exercise treadmill test.
Case Presentation:
A 40 year-old-man presented with recurrent retrosternal chest pain of 2 months duration. He had history of smoking and was obese, otherwise no physical abnormalities were detected by examination. Electrocardiogram and blood tests were normal apart from impaired glucose tolerance with elevated triglycerides and decreased level of high density lipoprotein cholesterol. While doing exercise treadmill test, the patient developed chest pain and significant ST-segment elevation in almost all precordial leads that persisted for about 15 minutes through recovery. We decided to admit the patient to the coronary care unit for further management and to perform coronary angiogram. Myocardial bridging was observed in the mid segment of the left anterior descending coronary artery. Medical treatment was decided.At one year follow up, our patient was healthy and had no cardiac complaints. In conclusion, myocardial bridging may predispose to coronary vasospasm that may leads to ischemic complications.
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