Key result
Coexisting mid-ventricular obstructive HCM, apical aneurysm, and myocardial bridging can trigger nonobstructive acute coronary syndrome.
Why the study?
The frequent coexistence of myocardial bridging and hypertrophic cardiomyopathy complicates the determination of myocardial bridging's contribution to myocardial ischemia.
Case Report (n=1)
No
This case highlights that the rare combination of mid-ventricular obstructive hypertrophic cardiomyopathy, an apical aneurysm, and myocardial bridging should be considered in the differential diagnosis of MINOCA, warranting individualized risk assessment and medical therapy.
Hypertrophic cardiomyopathy is a common inherited cardiac disease characterized by unexplained left ventricular hypertrophy in the absence of abnormal loading conditions. Myocardial bridging occurs when a segment of an epicardial coronary artery follows an intramyocardial course beneath an overlying muscular bridge. This anatomical variant is frequently observed in patients with hypertrophic cardiomyopathy, and its clinical manifestations may closely resemble those of the underlying cardiomyopathy. The frequent coexistence of these two entities makes it challenging to determine the precise contribution of myocardial bridging to myocardial ischemia. Case summary We present the case of a patient with obstructive mid-ventricular hypertrophic cardiomyopathy and an apical aneurysm who presented with a non-ST-segment elevation myocardial infarction. Coronary angiography revealed no significant obstructive coronary artery disease but demonstrated myocardial bridging of the mid-left anterior descending artery. Conclusion The coexistence of obstructive mid-ventricular hypertrophic cardiomyopathy, an apical aneurysm, and myocardial bridging of the left anterior descending artery is exceptionally rare and highlights the complex interplay among dynamic systolic obstruction, microvascular ischemia, and apical remodeling, with important implications for diagnostic evaluation and individualized management.
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Saidi et al. (2026) conducted a case report in Acute coronary syndrome in mid-ventricular obstructive hypertrophic cardiomyopathy (n=1). Myocardial bridging was evaluated. The rare coexistence of mid-ventricular obstructive hypertrophic cardiomyopathy, an apical aneurysm, and myocardial bridging can precipitate acute coronary syndrome without obstructive coronary disease.
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