Deep and long myocardial bridge
A 67-year-old man presented to the emergency department with left-sided chest pain that occurred while he was sleeping. He had experienced similar symptoms once a month for the past 3 years but did not experience any chest pain during physical activity. He did not have any risk factors for coronary heart disease, such as hypertension, obesity, dyslipidemia, cigarette smoking or diabetes mellitus. Electrocardiogram and echocardiography revealed no abnormality. Laboratory tests including serum creatine kinase and troponin levels were normal. Variant angina pectoris was suspected based on clinical manifestations, and an electrocardiogram-gated computed tomography coronary angiography (CTCA) was performed for excluding coronary artery stenosis. A 3D reconstruction image of CTCA (Figure 1A) revealed the midportion of the left anterior descending artery (LAD) coursing within the myocardium. While the curved multiplanar reconstruction (MPR) at 75% of the R-R interval (Figure 1B) revealed patency of the segment during diastole, the curved MPR at 40% of the R-R interval (Figure 1C) revealed severe stenosis of the segment during systole. The patient was diagnosed as having deep and long myocardial bridge (MB) of the LAD. The patient has been effectively treated with a beta-blocker and a calcium antagonist for the past 2 years.
Source: QJM - Category: Internal Medicine Source Type: research
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