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When the Heart Cries Wolf: Myocardial Bridging Presenting as Angina-like Chest Pain

Fnu Farukhuddin1, Muhammad Akrmah2, Maryam R Hussain2

  • 1Neurology, University Hospital Cleveland Medical Center, Cleveland, USA.

Cureus
|October 18, 2019
PubMed

Insights

Myocardial bridging, a common congenital heart anomaly, can cause angina-like chest pain. This case highlights a rare mid-segment LAD artery compression, emphasizing diagnostic challenges in atypical chest pain presentations.

Area of Science:

  • Cardiology
  • Congenital Heart Disease

Background:

  • Myocardial bridging (MB) is the most common congenital coronary anomaly, characterized by an epicardial coronary artery segment tunneling through the myocardium.
  • The left anterior descending artery (LAD) is most frequently affected, often associated with hypertrophic cardiomyopathy (HCM).

Observation:

  • A 64-year-old female presented with severe, non-exertional left-sided chest pain.
  • Initial electrocardiography (EKG) and echocardiography were unremarkable, but stress EKG revealed significant ST-segment depressions.

Findings:

  • Coronary angiography demonstrated systolic compression of the mid-segment LAD artery, with normal caliber during diastole.
  • This presentation is atypical due to the mid-segment involvement and severe anginal symptoms.

Implications:

  • This case underscores the diagnostic challenges posed by myocardial bridging presenting with atypical chest pain.
  • Early recognition and appropriate management, such as beta-blocker therapy, are crucial for patients with symptomatic myocardial bridging.

Keywords:
anginacoronary angiographymyocardial bridgingmyocardial ischemia

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