Why the study?
An increasing number of clinical scenarios have been demonstrated to result in pseudo-Wellens' syndrome, requiring unique forms of assessment and management beyond thromboembolic coronary occlusion.
Myocardial bridging of the LAD is a rare but important cause of pseudo-Wellens' syndrome that mimics occlusive coronary events.
Myocardial bridging warrants consideration in pseudo-Wellens' syndrome; case reports leave open its prevalence and evaluation strategy.
INTRODUCTION: Wellens' syndrome represents an important, at times overlooked, spectrum of left anterior descending (LAD) coronary artery occlusion, spontaneous reperfusion, and impending reocclusion. Once considered pathognomonic for a thromboembolic coronary event, an increasing number of clinical scenarios have been demonstrated to result in pseudo-Wellens' syndrome, each requiring unique forms of assessment and management. CASE REPORT: We describe two clinical presentations in which myocardial bridging (MB) of the LAD led to clinical and electrophysiologic presentations of a pseudo-Wellens' syndrome. CONCLUSION: These reports represent a rare cause of pseudo-Wellens' syndrome attributed to MB of the LAD. Transient ischemia secondary to myocardial compression of the traversing LAD leads to intermittent angina and electrocardiogram changes that are typical in patients presenting with Wellens' syndrome secondary to an occlusive coronary event. As with other previously reported pathophysiologic mechanisms that have been shown to mimic Wellens' syndrome, myocardial bridging should be considered in patients presenting with a pseudo-Wellens' syndrome.
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Guha et al. (2023) studied this question.
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