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Case Studies | Medicine | Indonesia | Volume 12 Issue 6, June 2023 | Rating: 5.1 / 10

The Impact of Myocardial Bridging on Coronary Artery Spasm in Female Patient without Significant Atherosclerotic Stenosis: A Case Report

Padmi Suwari CI | Erna Bagiari

Abstract: Background: Chest pain due to ACS is frequently a diagnostic concern of emergency physicians. However, this symptom can also present due to compression of the coronary artery by myocardial bridging (MB). MB is a frequent but often forgotten cause of angina. It has been accepted that MB might affect the cardiovascular system and sudden cardiac death have been reported. Case Illustration: A 43 year old woman with no significant past medical history, presented to the emergency departement with a sudden achy radiating pain in her left chest. No physical abnormalities were detected by clinical examination. Laboratory workup revealed high values for total cholesterol & cardiac troponin I. We did serial ECG and it exhibited any acute ischemic changes less than 20 minutes. We established the diagnosis of NSTEMI & the patient was managed conservatively. Following her presentation, ECG findings compatible with deeply inverted T waves in anterior lead. Therefore, we suggested patient to do coronary angiography & it showed dynamic obstruction of the LAD due to MB. Discussion: MB may cause chronic angina pectoris, ACS or coronary spasm. The mechanism behind these symptoms lies in the disturbance of blood flow through the tunneled artery. Our patient described sudden angina and her ECG showed a 2 to 3 mm ST elevation in anterior lead which returned to baseline quickly. This transient ST elevation is the key for the diagnosis coronary artery spasm (CAS). Coronary spasm frequently occur at MB segments because of endothelial or vascular dysfunction of the coronary artery at MB segments. Medication (beta-blockers & calcium channel blockers) is considered as first-line therapy and should be initiated only for symptomatic patients. Conclusions: MB is often forgotten cause of angina but can be present in up to 25% of the population. CAS frequently occur at MB segments. This condition coupled with any delay in management can lead to ischemia, infarction and sudden cardiac death.

Keywords: myocardial bridging, coronary artery spasm, angina

Edition: Volume 12 Issue 6, June 2023,

Pages: 2716 - 2719