Myocardial bridging causing ischemia and recurrent chest pain: a case report

Abstract

Background: Myocardial bridging is present when a segment of a major epicardial coronary artery runs intramurally through the myocardium. It usually has a benign prognosis, but in some cases myocardial ischemia, infarction and sudden cardiac death have been reported. We are here reporting a case of myocardial bridging which was complicated with recurrent chest pain and transient ST-segment elevation during exercise treadmill test.

Case presentation: A 40 year-old-man presented with recurrent retrosternal chest pain of 2 months duration. He had history of smoking and was obese, otherwise no physical abnormalities were detected by examination. Electrocardiogram and blood tests were normal apart from impaired glucose tolerance with elevated triglycerides and decreased level of high density lipoprotein cholesterol. While doing exercise treadmill test, the patient developed chest pain and significant ST-segment elevation in almost all precordial leads that persisted for about 15 minutes through recovery. We decided to admit the patient to the coronary care unit for further management and to perform coronary angiogram. Myocardial bridging was observed in the mid segment of the left anterior descending coronary artery. Medical treatment was decided.At one year follow up, our patient was healthy and had no cardiac complaints. In conclusion, myocardial bridging may predispose to coronary vasospasm that may leads to ischemic complications.

Figure 1

Early phase of exercise treadmill test with normal tracing.

Figure 2

Maximal exercise at which the test was terminated with ST-segment elevation in precordial leads.

Figure 3

Recovery phase of exercise treadmill test with still elevated ST-segment in precordial leads.

Figure 4

Normalised ST-segment in precordial leads at late recovery.

Figure 5

Systolic compression at the mid-portion of LAD at the LAO view (A), with normalization of systolic compression (B).