Key result
IVUS and provocation testing reveal diffuse epicardial spasm coexisting with a long myocardial bridge.
Why the study?
Positive ischemia on noninvasive imaging often results in nonobstructive disease on cardiac catheterization, posing diagnostic and management challenges when myocardial bridge and coronary spasm coexist.
Case Report (n=1)
This case highlights the coexistence of epicardial spasm in the area of a myocardial bridge and the diagnostic utility of IVUS and spasm provocation testing.
May support spasm provocation testing in myocardial bridge with ischemia; hypothesis-generating for coexistence without microvascular dysfunction.
Positive ischemia by noninvasive imaging studies often results in nonobstructive disease in cardiac catheterization. In this case, we observed ischemia by nuclear stress test in only the anteroseptal area, and the apex is free of ischemia. Coronary angiogram findings were unremarkable, but intravascular ultrasound confirmed the long length of the myocardial bridge. Further testing with spasm provocation and microvascular testing showed diffuse epicardial spasm in this area of myocardial bridge without microvascular dysfunction. We observed the myocardial bridge but no microvascular dysfunction. This case illustrates the coexistence of spasm in the area of a myocardial bridge and the challenges in the medical management of these patients. (Level of Difficulty: Advanced.)
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Ha et al. (2023) conducted a case report in Myocardial bridge and coronary artery spasm (n=1). Intravascular ultrasound and spasm provocation testing was evaluated. Intravascular ultrasound and spasm provocation testing revealed the coexistence of diffuse epicardial spasm in the area of a long myocardial bridge without microvascular dysfunction.
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