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European Heart Journal. Acute... Jun 2022
Topics: Coronary Angiography; Coronary Vessels; Humans; MINOCA; Myocardial Bridging; Myocardial Infarction
PubMed: 35695262
DOI: 10.1093/ehjacc/zuac074 -
The American Journal of Case Reports Jul 2020BACKGROUND Myocardial bridging, although frequent, is often a forgotten cause of angina. It is a congenital anomaly in which the coronary artery tunnels through the...
BACKGROUND Myocardial bridging, although frequent, is often a forgotten cause of angina. It is a congenital anomaly in which the coronary artery tunnels through the myocardium with the overlying muscle, termed a myocardial bridge. The tunneled artery is prone to increased myocardial compression, mechanical load, endothelial damage, and vascular remodeling. During myocardial systole, the tunneled artery undergoes narrowing caused by myocardial compression, which leads to disruption of blood flow, thereby precipitating angina, arrhythmias, infarction, and sudden cardiac death. CASE REPORT Here, we present a case of a 29-year-old white woman who presented with atypical left-sided achy chest pain, occurring primarily at rest. Further evaluation showed mildly elevated troponins, with normal electrocardiogram, chest x-ray, and CTA chest. She subsequently underwent coronary angiography and was found to have myocardial bridging of her left anterior descending artery, with compression of up to 40% during systole. She was initially treated with diltiazem, but due to adverse effects was transitioned to metoprolol succinate, which she has tolerated well. CONCLUSIONS Myocardial bridging, although benign in nature, carries a vast array of complications requiring these patients to undergo prompt diagnosis and treatment. Vascular spasm, wall stress of the tunneled artery, and intensity of systolic constriction coupled with any delay in management can lead to ischemia, infarction, dysrhythmias, and death. Therefore, it is imperative that patients who have low clinical suspicion for atherosclerosis but who are presenting with anginal equivalents undergo coronary angiography to assess for myocardial bridging and receive immediate treatment.
Topics: Adult; Anti-Arrhythmia Agents; Biomarkers; Chest Pain; Coronary Angiography; Female; Humans; Metoprolol; Myocardial Bridging; Troponin
PubMed: 32683394
DOI: 10.12659/AJCR.923075 -
Reviews in Cardiovascular Medicine Dec 2019The objective of this study was to explore the effects of myocardial bridge compression on blood flow, normal stress, circumferential stress and shear stress in mural...
The objective of this study was to explore the effects of myocardial bridge compression on blood flow, normal stress, circumferential stress and shear stress in mural coronary artery. An original mural coronary artery simulative device has been greatly improved and its measured hemodynamic parameters have been expanded from a single stress (normal stress) to multiple stresses to more fully and accurately simulate the true hemodynamic environment under normal stress, circumferential stress and shear stress. This device was used to more fully explore the relationship between hemodynamics and mural coronary atherosclerosis under the combined effects of multiple stresses. Results obtained from the mural coronary artery simulator showed stress abnormality to be mainly located in the proximal mural coronary artery where myocardial bridge compression was intensified and average and fluctuation values (maximum minus minimum) of proximal stress were significantly increased by 27.8% and 139%, respectively. It is concluded that myocardial bridge compression causes abnormalities in the proximal hemodynamics of the mural coronary artery. This is of great significance for understanding the hemodynamic mechanism of coronary atherosclerosis and has potential clinical value for the pathological effect and treatment of myocardial bridge.
Topics: Computer Simulation; Coronary Circulation; Coronary Vessels; Hemodynamics; Humans; Models, Anatomic; Models, Cardiovascular; Myocardial Bridging; Stress, Mechanical
PubMed: 31912719
DOI: 10.31083/j.rcm.2019.04.554 -
American Journal of Physiology. Heart... Dec 2019Myocardial bridging (MB) is linked to angina and myocardial ischemia and may lead to sudden cardiac death in patients with hypertrophic cardiomyopathy (HCM). However, it...
Myocardial bridging (MB) is linked to angina and myocardial ischemia and may lead to sudden cardiac death in patients with hypertrophic cardiomyopathy (HCM). However, it remains unclear how MB affect the coronary blood flow in HCM patients. The aim of this study was to assess the effects of MB on coronary hemodynamics in HCM patients. Fifteen patients with MB (7 HCM and 8 non-HCM controls) in their left anterior descending (LAD) coronary artery were chosen. Transient computational fluid dynamics (CFD) simulations were conducted in anatomically realistic models of diseased (with MB) and virtually healthy (without MB) LAD from these patients, reconstructed from biplane angiograms. Our CFD simulation results demonstrated that dynamic compression of MB led to diastolic flow disturbances and could significantly reduce the coronary flow in HCM patients as compared with non-HCM group ( < 0.01). The pressure drop coefficient was remarkably higher ( < 0.05) in HCM patients. The flow rate change is strongly correlated with both upstream Reynolds number and MB compression ratio, while the MB length has less impact on coronary flow. The hemodynamic results and clinical outcomes revealed that HCM patients with an MB compression ratio higher than 65% required a surgical intervention. In conclusion, the transient MB compression can significantly alter the diastolic flow pattern and wall shear stress distribution in HCM patients. HCM patients with severe MB may need a surgical intervention. In this study, the hemodynamic significance of myocardial bridging (MB) in patients with hypertrophic cardiomyopathy (HCM) was investigated to provide valuable information for surgical decision-making. Our results illustrated that the transient MB compression led to complex flow patterns, which can significantly alter the diastolic flow and wall shear stress distribution. The hemodynamic results and clinical outcomes demonstrated that patients with HCM and an MB compression ratio higher than 65% required a surgical intervention.
Topics: Adolescent; Adult; Aged; Cardiomyopathy, Hypertrophic; Coronary Circulation; Female; Hemodynamics; Humans; Male; Middle Aged; Models, Cardiovascular; Myocardial Bridging; Patient-Specific Modeling
PubMed: 31674812
DOI: 10.1152/ajpheart.00466.2019 -
Current Problems in Cardiology Jan 2024Hypertrophic cardiomyopathy (HCM) is a complex cardiac disorder, often associated with adverse outcomes, including sudden cardiac death. Myocardial bridging (MB), where... (Review)
Review
Hypertrophic cardiomyopathy (HCM) is a complex cardiac disorder, often associated with adverse outcomes, including sudden cardiac death. Myocardial bridging (MB), where a coronary artery segment traverses intramurally within the myocardium, complicates coronary blood flow dynamics. This retrospective study investigates the relationship between MB and HCM and their impact on percutaneous coronary intervention (PCI) outcomes. Data from the 2019 National Inpatient Sample (NIS), representing 20% of U.S. hospitalizations, was utilized. Patients with both HCM and MB undergoing PCI were identified and analyzed. The study assessed inpatient outcomes, including mortality, length of stay, hospital cost, and post-PCI complications (atrial fibrillation, acute kidney injury, bleeding, coronary dissection). Patients with HCM and MB exhibited distinct demographics. The study did not find significant associations between HCM/MB and inpatient mortality, length of stay, or hospital cost. However, HCM patients had a higher incidence of atrial fibrillation and acute kidney injury post-PCI (aOR 2.33, 95% CI 1.46 to 3.71, p ≤ 0.001). MB was linked to increased occurrences of acute heart failure (aOR 0.62, 95% CI 0.42-0.92, p = 0.02) and post-PCI bleeding (aOR 4.88, 95% CI 1.17-20.2, p = 0.03). This nationwide study reveals unique demographic profiles for HCM and MB patients. Notably, HCM patients face higher risks of post-PCI complications, including atrial fibrillation and acute kidney injury. These findings provide fresh insights into the MB-HCM relationship and its implications for PCI outcomes. They emphasize the need for tailored interventions and improved patient management in cases involving both HCM and MB.
Topics: Humans; Percutaneous Coronary Intervention; Retrospective Studies; Myocardial Bridging; Atrial Fibrillation; Hemorrhage; Cardiomyopathy, Hypertrophic; Acute Kidney Injury; Risk Factors; Treatment Outcome
PubMed: 37722520
DOI: 10.1016/j.cpcardiol.2023.102080 -
Revista Portuguesa de Cardiologia Mar 2019The authors report a rare clinical case of myocardial bridging of the three major coronary arteries, which manifested in an unusual way with severe biventricular...
The authors report a rare clinical case of myocardial bridging of the three major coronary arteries, which manifested in an unusual way with severe biventricular dysfunction in the context of tachycardia. For the diagnosis, the authors relied on non-invasive multimodality cardiac imaging, including cardiac magnetic resonance, computed tomography angiography and myocardial perfusion scintigraphy. The implementation of targeted medical and neurohormonal therapy resulted in the recovery of ventricular function and clinical improvement.
Topics: Adult; Computed Tomography Angiography; Coronary Angiography; Coronary Vessels; Diagnosis, Differential; Echocardiography; Female; Humans; Imaging, Three-Dimensional; Magnetic Resonance Imaging, Cine; Myocardial Bridging; Myocardial Stunning
PubMed: 30031629
DOI: 10.1016/j.repc.2017.09.030 -
The American Journal of the Medical... May 2023
Topics: Humans; Myocardial Bridging; Coronary Angiography; Coronary Vessel Anomalies
PubMed: 36574817
DOI: 10.1016/j.amjms.2022.12.021 -
Medicine Oct 2020Coronary chest pain is usually ischemic in etiology and has various electrocardiographic presentations. Lately, it has been recognized that myocardial bridging (MB) with...
RATIONALE
Coronary chest pain is usually ischemic in etiology and has various electrocardiographic presentations. Lately, it has been recognized that myocardial bridging (MB) with severe externally mechanical compression of an epicardial coronary artery during systole may result in myocardial ischemia. Such a phenomenon can be associated with chronic angina pectoris, acute coronary syndromes (ACS), coronary spasm, ventricular septal rupture, arrhythmias, exercise-induced atrioventricular conduction blocks, transient ventricular dysfunction, and sudden death.
PATIENT CONCERNS
We report the case of a 58-year-old woman presenting with recurrent episodes of constrictive chest pain during exercise within the last 2 weeks. Except for obesity, general and cardiovascular clinical examination on admission were normal.
DIAGNOSES
The resting 12 lead electrocardiogram (ECG) revealed changes typically for Wellens syndrome. High-sensitive cardiac troponin I was normal. We established the diagnosis of low-risk non-ST-segment elevation acute coronary syndrome with a Global Registry of Acute Coronary Events risk score of 92 points.
INTERVENTIONS
The patient underwent coronary angiography, who showed subocclusive dynamic obstruction of the left anterior descending artery due to MB.
OUTCOMES
The patient was managed conservatively. Her hospital course was uneventful and she was discharged on pharmacological therapy (clopidogrel, bisoprolol, amlodipine, atorvastatin, and metformin) with well-controlled symptoms on followup.
LESSONS
MB is an unusual cause of myocardial ischemia. Wellens syndrome is an unusual presentation of ACS. We present herein a rare case of Wellens syndrome caused by MB. This case highlights the importance of subtle and frequently overseen ECG findings when assessing patients with chest pain and second, the importance of considering nonatherosclerotic causes for ACS.
Topics: Acute Coronary Syndrome; Chest Pain; Coronary Angiography; Coronary Occlusion; Electrocardiography; Female; Humans; Middle Aged; Myocardial Bridging; Syndrome
PubMed: 33031283
DOI: 10.1097/MD.0000000000022491 -
Journal of Cardiology Dec 2017Prevalence of myocardial bridging of the left anterior descending coronary artery (LAD) in patients with takotsubo syndrome (TTS) has been demonstrated. However, the...
BACKGROUND
Prevalence of myocardial bridging of the left anterior descending coronary artery (LAD) in patients with takotsubo syndrome (TTS) has been demonstrated. However, the impact of myocardial bridging on in-hospital outcome has not been fully evaluated.
METHODS
A total of 144 consecutive patients with TTS were enrolled. Coronary angiography and left ventriculography were performed in all patients and absence of obstructive coronary disease explaining the left ventricular contraction abnormality was confirmed. Myocardial bridging was diagnosed when a dynamic compression in systole, so-called "milking effect", was observed in the LAD. We evaluated differences in the clinical characteristics and in-hospital outcome between patients with and without myocardial bridging. Furthermore, multiple logistic regression analysis was performed to predict in-hospital death.
RESULTS
Myocardial bridging was observed in 33 patients (23%). In-hospital death was more frequent in patients with myocardial bridging (21% vs. 6%, p=0.02), which was due mainly to a higher non-cardiac death in those patients (15% vs. 5%, p=0.049). Multiple logistic regression analysis demonstrated myocardial bridging (odds ratio=12.0, 95% CI=2.52-78.5, p<0.01) as one of the independent predictors of in-hospital death.
CONCLUSION
Myocardial bridging is an independent predictor of in-hospital death in patients with TTS.
Topics: Aged; Aged, 80 and over; Coronary Angiography; Coronary Vessels; Female; Hospital Mortality; Hospitalization; Humans; Male; Middle Aged; Myocardial Bridging; Prevalence; Takotsubo Cardiomyopathy
PubMed: 28522138
DOI: 10.1016/j.jjcc.2017.04.004 -
Nihon Rinsho. Japanese Journal of... Sep 2007
Review
Topics: Adrenergic beta-Antagonists; Aged; Calcium Channel Blockers; Coronary Artery Bypass; Diagnostic Imaging; Female; Humans; Myocardial Bridging; Prognosis; Stents
PubMed: 17948710
DOI: No ID Found