Myocardial Bridging-Induced Acute Coronary Syndrome: A Bridge Too Far
Priya Ramcharan1, Arun R Katwaroo2, Reyaz Hosein3
1Cardiology, North Central Regional Health Authority, Mt. Hope, TTO.
Insights
Myocardial bridging (MB) may accelerate atherosclerosis, increasing risks for acute coronary syndrome (ACS). This case highlights MB management in ACS, emphasizing guideline-directed therapy and percutaneous coronary intervention.
Area of Science:
- Cardiology
- Vascular Biology
- Medical Case Reports
Background:
- Myocardial bridging (MB) is increasingly recognized as a potential contributor to coronary artery disease (CAD).
- Accelerated atherosclerotic plaque formation has been suggested in association with MB.
- Understanding the clinical implications of MB in acute coronary syndrome (ACS) is crucial.
Observation:
- A 37-year-old South Asian male with no traditional CAD risk factors presented with non-ST-segment-elevation acute coronary syndrome (NSTE-ACS).
- The patient exhibited a severe MB coincident with a critical 'widowmaker' lesion.
- This presentation underscores the potential link between MB and severe CAD events.
Findings:
- Successful management involved guideline-directed medical therapy (GDMT) and urgent percutaneous coronary intervention (PCI).
- The PCI strategy successfully treated the culprit lesion while preserving the bridged segment.
- This approach highlights a feasible treatment pathway for MB-associated ACS.
Implications:
- Clinicians must consider MB as a significant factor in major adverse cardiovascular events (MACE), including ACS.
- Awareness of MB's role prompts consideration of specific diagnostic and management strategies.
- This case emphasizes the importance of tailored PCI and GDMT in patients with MB and ACS.
Abstract:
Recent studies suggest a potential association between myocardial bridging (MB) and accelerated atherosclerotic plaque formation. We describe the case report of a 37-year-old South Asian male with no established risk factors for coronary artery disease (CAD) who presented with a non-ST-segment-elevation acute coronary syndrome (NSTE-ACS) with a coincident widowmaker lesion and severe MB. He was successfully managed with comprehensive guideline-directed medical therapy (GDMT) and urgent percutaneous coronary intervention (PCI) of the culprit lesion, sparing the MB segment. The clinician should be cognizant of MB implicating ACS as a major adverse cardiovascular event (MACE) and its key management strategies.
Related Concept Videos
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:26Imbalances in Cardiac Output
CHF can occur due to the failure of either side of the heart. Left-side failure leads to pulmonary congestion—the right side continues to send...
01:17Ischemic Heart Disease: Overview
Atherosclerosis, the primary malefactor, orchestrates this dangerous condition. It manifests as the accumulation of fatty deposits, akin to insidious plaques, within arterial walls. As time elapses, these plaques metamorphose, hardening and...