Transient ST-Segment Elevations in a Patient With Intramyocardial LAD Bridging
Ranvir Bhatia1, Neel Chokshi1, Dinesh Jagasia1
1Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Insights
Myocardial bridges, often asymptomatic, pose management challenges. This case highlights transient ST-segment elevations in a patient with left anterior descending artery bridging, suggesting silent myocardial ischemia.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Clinical Case Studies
Background:
- Myocardial bridges are congenital anomalies where a segment of coronary artery travels through myocardial muscle.
- Functionally characterizing myocardial bridges and managing potential silent ischemia remains a clinical challenge.
Observation:
- A patient presented with asymptomatic, transient ST-segment elevations in the emergency department.
- Diagnostic workup revealed a myocardial bridge in the mid to distal left anterior descending artery.
Findings:
- The presence of a myocardial bridge in the left anterior descending artery was confirmed.
- Transient ST-segment elevations raised concern for exercise-induced or stress-induced silent myocardial ischemia.
Implications:
- This case underscores the importance of considering myocardial bridging in patients with unexplained ST-segment changes.
- Further investigation into the functional significance of myocardial bridges is crucial for appropriate patient management and risk stratification.
Abstract:
Although often clinically silent, myocardial bridges are challenging to functionally characterize and subsequently manage. Here we describe a patient with asymptomatic, transient ST-segment elevations in the emergency room, found to have mid to distal left anterior descending artery bridging raising concern for silent ischemia.
