Bridge of the left anterior descending artery revealed by syncope: a case report

Area of Science:

• Cardiology
• Congenital Heart Disease
• Vascular Biology

Background:

• Myocardial bridges are congenital anomalies where heart muscle overlays a coronary artery.
• Symptoms can range from asymptomatic to angina, myocardial infarction, and arrhythmias.
• This case involves a diabetic patient with a history of neglected stress angina presenting with syncope.

Purpose of the Study:

• To investigate the link between myocardial bridges and paroxysmal conduction disorders.
• To illustrate a case of syncope caused by an intramyocardial bridge of the left anterior descending artery.
• To emphasize that ischemic conduction disorders can arise from myocardial bridges, not solely atherosclerotic lesions.

Main Methods:

• Case report of a 51-year-old male patient.
• Electrocardiogram (ECG) on admission.
• Coronary angiography to visualize coronary arteries and identify myocardial bridges.
• Clinical correlation of symptoms, ECG findings, and angiographic results.

Main Results:

• Patient presented with syncope, bradycardia (32 bpm), and complete atrioventricular block, recovering to sinus rhythm (88 bpm) with a PR interval of 200 ms.
• Coronary angiography revealed an intramyocardial bridge of the left anterior descending artery without significant stenosis.
• Systolic compression of the artery due to the myocardial bridge during exercise was implicated as the cause of reduced blood flow and conduction abnormalities.

Conclusions:

• Myocardial bridges can cause significant hemodynamic changes during exertion, leading to ischemia and conduction disturbances.
• Syncope in this patient was attributed to paroxysmal conduction disorders secondary to the myocardial bridge.
• This case underscores the importance of considering myocardial bridges as a potential cause of ischemic conduction disorders, even in the absence of atherosclerosis.