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Coronary vasospasm at the site of myocardial bridge--report of two cases
1Second Department of Internal Medicine, Ehime University School of Medicine, Japan.
Angiology
|August 26, 1998
Insights
Myocardial bridges can cause vasospastic angina. Isosorbide dinitrate resolved coronary vasospasm, and calcium channel blockers effectively managed symptoms in two patients.
Area of Science:
- Cardiology
- Vascular Medicine
- Cardiac Surgery
Background:
- Myocardial bridges are a congenital anomaly where a segment of coronary artery tunneled through heart muscle.
- Coronary vasospasm can cause angina pectoris, particularly in post-myocardial infarction patients.
- Understanding vasospasm mechanisms is crucial for effective angina management.
Observation:
- Two patients presented with angina pectoris and post-myocardial infarction angina.
- Symptoms were attributed to coronary vasospasm at the site of a myocardial bridge.
- Acetylcholine provocation tests were used to assess coronary vasoreactivity.
Findings:
- Intracoronary isosorbide dinitrate administration successfully resolved coronary vasospasm in both patients.
- Vasospastic angina pectoris demonstrated significant improvement following treatment with calcium channel blockers.
- This suggests a specific therapeutic response in patients with myocardial bridging-associated vasospasm.
Implications:
- Myocardial bridges should be considered in the differential diagnosis of refractory angina, especially post-MI.
- Pharmacological interventions targeting vasospasm, such as calcium channel blockers, can be effective.
- Further research into the pathophysiology and optimal management of myocardial bridging-related vasospasm is warranted.
Abstract:
Two patients with angina pectoris and postmyocardial infarction angina due to coronary vasospasm at the site of myocardial bridge are described. Intracoronary injection of isosorbide dinitrate led to resolution of coronary vasospasm on acetylcholine provocation test, and vasospastic angina pectoris has been well controlled after treatment with calcium channel blockers.