The Case of the Acute Myocardial Infarction at the Congenital Anomaly of the Heart – The Myocardial Bridge

Muscle bridges in the human heart are benign developmental abnormalities that can lead to acute myocardial ischemia. Muscular myocardial bridges are often found in the region of the anterior interventricular artery, while the diameter of the coronary artery before the bridge is larger than after it. The gold standard for detecting this pathology is coronary angiography, which allows visualizing the internal contours of the coronary artery. The study makes it possible to give a qualitative assessment of the site of stenosis with the determination of the cause of its occurrence. Angiographic signs of this pathology can include curvature of the segment of the affected coronary artery, uniform narrowing of the vessel lumen by more than 40% in systole and restoration of the diameter in diastole, clear signs of narrowing in at least two angiographic views, absence of vasoconstriction caused by pharmacological agents or a catheter. The aim of the study was to conduct a clinical and anatomical analysis of a case of acute myocardial infarction of type 2 caused by an anomaly in the development of the anterior interventricular artery. The analysis used data from the medical history, the results of intravital laboratory and instrumental studies, qualitative and quantitative morphological studies of the heart obtained during autopsy. The results of the study describe in detail at the macroscopic and microscopic levels the analyzed case of myocardial infarction against the background of an anomaly in the development of the anterior interventricular artery. The deceased patient has a history of comorbid pathology - myeloma. The authors suggest that an anomaly in the development of one of the branches of the left coronary artery in the form of a myocardial bridge and myeloma were pathogenic factors in the development of type 2 myocardial infarction of the anterior wall of the left ventricle. The immediate cause of death of the patient was acute left ventricular failure with pulmonary edema.