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Updated: Sep 14, 2025

Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Myocardial Bridging With Left Ventricular Hypertrophy: A Case of Exercise-Induced Cardiac Arrest With Coronary Spasm
Takumi Toya1, Kaoru Naito2, Tsukasa Urushima2
1Division of Cardiology, National Defense Medical College, Tokorozawa, Saitama, Japan; Department of Cardiology, NHO Tokyo Medical Center, Tokyo, Japan.
Background:
A 17-year-old male athlete experienced out-of-hospital cardiac arrest due to ventricular fibrillation during exercise. Myocardial bridging (MB) and vasospasm were identified as potential contributors to the event.
Case Summary:
Initial imaging revealed MB of the mid-left anterior descending artery embedded within hypertrophic myocardium. Physiological assessment demonstrated significant ischemia, and acetylcholine provocation testing induced epicardial spasm, confirming MB-induced ischemia with vasospasm. Fluorodeoxyglucose positron emission tomography showed increased tracer uptake, initially suggesting malignancy, but histopathology attributed this to ischemia-related metabolic changes. The patient underwent surgical unroofing with intraoperative confirmation of arterial decompression. Postoperatively, he was treated with diltiazem and bisoprolol.
Discussion:
This case underscores the interplay between MB and vasospasm in exercise-induced cardiac arrest and highlights surgical unroofing as a definitive treatment.
Take-Home Messages:
MB can contribute to life-threatening arrhythmias, particularly when complicated by vasospasm. Surgical unroofing with targeted medical therapy may optimize outcomes.
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