Myocardial Bridging: A Case Presentation of Atypical Chest Pain Syndrome in a Young Woman.

The American Journal of Case Reports
Shahnaz Duymun, Emmanuel Misodi

Abstract

BACKGROUND Myocardial bridging, although frequent, is often a forgotten cause of angina. It is a congenital anomaly in which the coronary artery tunnels through the myocardium with the overlying muscle, termed a myocardial bridge. The tunneled artery is prone to increased myocardial compression, mechanical load, endothelial damage, and vascular remodeling. During myocardial systole, the tunneled artery undergoes narrowing caused by myocardial compression, which leads to disruption of blood flow, thereby precipitating angina, arrhythmias, infarction, and sudden cardiac death. CASE REPORT Here, we present a case of a 29-year-old white woman who presented with atypical left-sided achy chest pain, occurring primarily at rest. Further evaluation showed mildly elevated troponins, with normal electrocardiogram, chest x-ray, and CTA chest. She subsequently underwent coronary angiography and was found to have myocardial bridging of her left anterior descending artery, with compression of up to 40% during systole. She was initially treated with diltiazem, but due to adverse effects was transitioned to metoprolol succinate, which she has tolerated well. CONCLUSIONS Myocardial bridging, although benign in nature, carries a vast array of co...Continue Reading

Methods Mentioned

BETA
ESR
coronary artery bypass
dissection

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