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Coronary atherosclerosis within a myocardial bridge, not a benign condition
R J de Winter1, W E Kok, J J Piek
1Department of Cardiology, University of Amsterdam, Netherlands. r.j.dewinter@amc.uva.nl
Heart (British Cardiac Society)
|October 9, 1998
Summary
Myocardial bridging typically prevents atherosclerosis, but a rare case showed plaque within the bridged artery. This highlights the need for intracoronary ultrasound screening in symptomatic patients with myocardial bridging.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Vascular Biology
Background:
- Myocardial bridging is a congenital anomaly where a segment of coronary artery tunneled within the heart muscle.
- Atherosclerotic disease is typically absent within the myocardial bridge segment.
- Coronary angiography is the standard imaging modality for coronary artery disease.
Observation:
- A 47-year-old male presented with symptoms suggestive of coronary artery disease.
- Coronary angiography did not reveal significant atherosclerotic lesions.
- Intravascular ultrasound (IVUS) identified an atherosclerotic plaque within the myocardial bridged segment.
Findings:
- This case represents a rare occurrence of atherosclerosis within a myocardial bridge.
- IVUS provided superior resolution for plaque detection compared to coronary angiography in this specific scenario.
- The presence of plaque within the bridged segment contributed to the patient's symptoms.
Implications:
- Myocardial bridging with coexisting atherosclerosis is not a benign condition.
- Symptomatic patients with myocardial bridging warrant further investigation for plaque within the bridged segment.
- Intracoronary ultrasound should be considered for screening bridged segments in symptomatic individuals to detect otherwise occult atherosclerotic disease.