Medical therapy with beta-blockers and calcium channel blockers is an effective initial strategy for managing myocardial ischemia in patients with concurrent myocardial bridging and hypertrophic obstructive cardiomyopathy.
May support medical therapy initially in this overlap; hypothesis-generating and requires prospective validation before practice change.
A 48-year-old man was admitted due to persistent chest tightness associated with cold sweats, hypotension and tachycardia. An electrocardiogram showed a sinus tachycardia with non-specific ST-T changes. Serial cardiac isoenzymes were not elevated. Unstable angina was diagnosed based on the clinical manifestations. Coronary angiography revealed no evidence of atherosclerosis but severe myocardial bridging in the middle third of the left anterior descending coronary artery which resulted in nearly total occlusion of the vessel in systole. Meanwhile, an echocardiogram revealed hypertrophic obstructive cardiomyopathy. The patient did well under medical treatment with bisoprolol and verapamil. In conclusion, both myocardial bridging and hypertrophic cardiomyopathy can cause myocardial ischemia and can be treated by calcium antagonists and/or beta-blocking agents. Coronary stenting can be performed to relieve the myocardial bridging but restenosis rate is high. Surgical myotomy or coronary artery bypass graft and transaortic subvalvular myectomy should be reserved when patients are refractory to medical treatment.
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Lin et al. (2008) studied this question.
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