Rare Occurrence of Syncope and Nodal Rhythm Caused by Left Anterior Descending Myocardial Bridge

A 59-year-old male presented to our clinic with a oneyear history of recurrent syncope, accompanied by chest pain, dizziness, and an urge to vomit.Each syncopal episode lasted less than one minute, with spontaneous recovery and no postictal confusion, distinguishing it from seizure activity.The chest pain, described as pressure-like and non-exertional, lasted approximately 20 minutes per episode.Previous neurologic evaluation, including brain computed tomography, was unremarkable, prompting a cardiac workup.The patient's medical history included hypertension and hyperlipidemia, managed with metoprolol 45.5 mg daily, acetylsalicylic acid 100 mg daily, and rosuvastatin 20 mg daily.He denied smoking, alcohol use, or allergies.On admission, vital signs were stable (blood pressure 135/85 mmHg, heart rate 45 bpm, respiratory rate 16 breaths/min, oxygen saturation 98%).An electrocardiogram (ECG) revealed a nodal rhythm at 45 bpm, characterized by narrow QRS complexes and absent P waves, consistent with a junctional escape rhythm (Figure 1A).Laboratory findings showed elevated troponin I of 911 ng/L (reference < 34.2 ng/L), indicating myocardial injury, while other tests, including electrolytes and renal function, were normal.