Key result
Beta-blocker therapy resolves angina in a case of myocardial bridging mimicking ACS.
Why the study?
Myocardial bridging can cause ischemia in patients without atherosclerosis but with hemodynamic risk factors, and its clinical implications require analysis.
Case Report (n=1)
Highlights myocardial bridging as a potential cause of acute coronary syndrome symptoms in the absence of atherosclerosis, which may be managed with beta-blockers.
Myocardial bridging may mimic ACS; this Level 5 case leaves open its diagnostic frequency and management.
The purpose of the study — to analyze the clinical case of the patient with symptoms of acute coronary syndrome taking into account clinical, laboratory and instrumental investigations. Material and methods. We investigate the clinical case of the patient who was conducted with acute coronary syndrome, but myocardial bridging was observed during the diagnostic manipulations. Results. Most frequently, myocardial bridging occurs at the level of mid-segment of anterior interventricular branch of left coronary artery. There are symptoms which can instigate ischemia such as spasm of coronary artery, tachycardia, myocardial hypertrophy caused by iatrogenic factors or hypertrophic cardiomyopathy. Сoronaroventriculography is the “golden criterion” of diagnostics, other methods of diagnostics are new methods of visualization and provocation tests. The opportunities of conservative and interventional treatment were assessed. Conclusion. Myocardial bridging can be a cause of ischemia of myocardium among the patients without markers of atherosclerosis but with factors of haemodynamic risk such as tachycardia, spasm of coronary artery or myocardial hypertrophy. Most frequently symptoms of acute coronary syndrome occur when myocardial bridging is located in the mid-segment of anterior interventricular branch of left coronary artery. It is caused because of the perpendicular position of muscle fiber to coronary artery which increases systolic compression. Diastolic function and blood filling can be enhanced by medical treatment with β-blockers, which are the first-line agents for the treatment of hypertrophic cardiomyopathy.
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Тащук et al. (2019) conducted a case report in Myocardial bridging mimicking acute coronary syndrome (n=1). Medical therapy (valsartan, hydrochlorothiazide, bisoprolol, trimetazidine, gidazepam) was evaluated on Clinical improvement (reduction of dyspnea, absence of heart pain, no ST segment dynamics on ECG). Medical therapy including beta-blockers led to significant clinical improvement and resolution of angina in a 56-year-old woman with a myocardial bridge mimicking acute coronary syndrome.
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