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Case Reports
. 2024 May 15;63(10):1377-1380.
doi: 10.2169/internalmedicine.2413-23. Epub 2023 Oct 6.

A Super-elderly Case of Suspected New-onset Vasospastic Angina Complicated by Myocardial Bridge

Satoshi Kurisu  1 , Hitoshi Fujiwara  1
Affiliations
Case Reports

A Super-elderly Case of Suspected New-onset Vasospastic Angina Complicated by Myocardial Bridge

Satoshi Kurisu et al. Intern Med. .

Abstract

A 90-year-old man experienced chest oppressive sensation at 12:30 AM for the first time. Electrocardiography showed a newly developed inversion of the terminal T-wave in the V2-5 leads. A left coronary angiogram showed no significant atherosclerotic stenosis. A myocardial bridge was found in the mid-left anterior descending artery (LAD). Myocardial scintigraphy with 123I beta-methyl 15-para-iodophenyl 3(R,S)-methylpentadecanoic acid revealed a reduced uptake in the apical and septal areas. Based on these findings, we suspected new-onset vasospastic angina complicated by a myocardial bridge in the territory of the LAD. He remained in good condition without recurrent anginal attacks after nifedipine was started before bedtime.

Keywords: coronary spasm; electrocardiogram; fatty acid metabolism; scintigraphy.

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Conflict of interest statement

The authors state that they have no Conflict of Interest (COI).

Figures

Figure 1.
Figure 1.
Serial electrocardiograms showed newly developed inversion of T-wave in precordial leads. A follow-up ECG obtained 11 days after admission showed a nearly normalized T-wave in precordial leads.
Figure 2.
Figure 2.
A left coronary angiogram showed no significant atherosclerotic stenosis, and a right coronary angiogram showed moderate atherosclerotic stenosis. A myocardial bridge was found in the mid left anterior descending artery (LAD) (arrows) distal to the second major septal branch (asterisks). Systolic compression of the mid segment was seen with return to a normal caliber during diastole.
Figure 3.
Figure 3.
A reduced uptake was seen in the apical and septal areas on 123I beta-methyl 15-para-iodophenyl 3(R, S) -methylpentadecanoic acid imaging.
See this image and copyright information in PMC

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