Myocardial bridge: bridging the differential diagnosis
Mayur Patel1, Brenen Swofford1, Edward Distler1
1Internal Medicine, University of Arizona College of Medicine Phoenix, Phoenix, Arizona, USA.
BMJ Case Reports
|October 29, 2017
Summary
A rare heart condition, myocardial bridge, can cause chest pain and is often missed. This case shows nitrates worsening symptoms, suggesting myocardial bridge as a diagnosis to consider.
Area of Science:
- Cardiology
- Cardiovascular Medicine
Background:
- Vasospastic angina can present with recurrent chest pain.
- Nitroglycerin and isosorbide are common treatments for angina.
Observation:
- A 50-year-old man experienced worsening chest pain after nitroglycerin administration.
- Electrocardiogram (ECG) showed no ischemic changes, and initial troponin levels were negative.
Findings:
- Left heart catheterization revealed a myocardial bridge in the mid-left anterior descending artery.
- Myocardial bridging is an uncommon cause of angina and other cardiac events.
Implications:
- Chest pain evaluation should include myocardial bridging, especially when nitrates exacerbate symptoms.
- This case underscores the importance of considering rare diagnoses in cardiology.
Related Concept Videos
01:27Myocarditis II: Clinical Features and Diagnostic Tests
355
Myocarditis is an inflammation of the heart muscle. The symptoms vary widely, encompassing asymptomatic presentations to severe, acute manifestations.Clinical PresentationAsymptomatic cases: In some instances, myocarditis may be asymptomatic, with the infection resolving without intervention. These cases often go undetected unless discovered incidentally through diagnostic imaging or tests conducted for other reasons.General Early Symptoms: Early symptoms of myocarditis are non-specific and can...
355
01:23Mitral Stenosis II: Clinical features and Diagnostic Tests
300
Mitral stenosis is a heart condition in which the mitral valve, which allows blood to flow from the left atrium to the left ventricle, becomes narrowed or stenotic. This narrowing hinders blood flow and leads to clinical symptoms requiring specific medical evaluations and management strategies. The following overview outlines the clinical symptoms, assessments, diagnostic findings, prevention methods, and treatments for mitral stenosis.Clinical ManifestationsDyspnea (shortness of breath): This...
300
01:30Acute Coronary Syndrome III: Diagnostic Studies
309
Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
309
01:25Cardiomyopathy I: Introduction and Classification
645
Cardiomyopathy, or CMP, is a group of diseases affecting the myocardial structure, impairing its ability to pump blood effectively. This condition can lead to arrhythmias, heart failure, or sudden cardiac death.Cardiomyopathies are classified into primary and secondary categories:Primary Cardiomyopathy refers to conditions involving only the heart muscle that are often idiopathic (of unknown cause) or genetic. They primarily affect the myocardium without the involvement of other systemic...
645
01:30Cardiomyopathy II: Dilated Cardiomyopathy
622
Dilated cardiomyopathy, or DCM, is a progressive myocardial disorder characterized by ventricular chamber dilation and contractile dysfunction.EtiologyVarious factors can cause DCM, including hypertension and heavy alcohol intake, which contribute to the weakening and enlargement of the heart muscle. Viral infections, such as Coxsackievirus B, adenoviruses, and influenza, can lead to DCM by causing inflammation and damage to heart tissue. Certain chemotherapeutic agents, including daunorubicin,...
622
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy
540
Hypertrophic cardiomyopathy, or HCM, is an autosomal dominant genetic disorder characterized by asymmetric left ventricular hypertrophy without ventricular dilation. It is more common in men and is typically diagnosed in young, athletic adults.EtiologyHCM is primarily genetic and is caused by mutations in genes encoding sarcomeric proteins. Researchers have identified over 1400 mutations across at least 11 different genes. Among these, the most frequently occurring mutations are found in the...
540