Chest
Selected ReportsMyocardial Bridging as a Cause of Acute Transient Left Heart Dysfunction
Section snippets
Case Report
A 63-year-old woman was admitted to our Cardiology Department a few days after she received intensive care treatment for acute pulmonary edema, preceded by angina pectoris without myocardial infarction. Her medical history was limited to atrial fibrillation, known since 1991, that was treated with digoxin. In 1995, she began complaining of typical rest angina and showed no evidence of myocardial ischemia by dipyridamole single-photon emission CT (SPECT). On admission, the clinical examination
Discussion
Most reports315 on myocardial bridging have emphasized its good prognosis. Various arguments support this analysis. First, the high frequency of myocardial bridges in autopsy studies stands in contrast to the rarity of symptomatic cases. Second, symptoms usually start in patients > 30 years old.1617Nevertheless, this point of view has been challenged in several reports, and serious ischemic events have been linked with myocardial bridges.6789101112131819 Induction of ischemia solely by a
Conclusion
Myocardial bridging-induced ischemia can be severe enough to generate clinical signs of acute left heart dysfunction, which is reversible after debridging in the absence of evolving myocardial infarction and/or myocardial stunning. Even in the presence of localized LVH, myocardial bridging-induced ischemia might favor further diastolic dysfunction, which can fully explain acute left heart dysfunction. This report, together with those previously published, suggests that myocardial bridging can
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Cited by (44)
Myocardial bridging: Contemporary understanding of pathophysiology with implications for diagnostic and therapeutic strategies
2014, Journal of the American College of CardiologyCitation Excerpt :These data suggest that both systolic and diastolic flow impairment contribute to myocardial supply-demand mismatch in patients with myocardial bridging. Although myocardial bridging can be an incidental finding on angiography or autopsy, symptomatic patients who have myocardial bridges as their only cardiac abnormality may present with myocardial ischemia (21), acute coronary syndromes (22–24), coronary spasm (21,25), exercise-induced dysrhythmias such as supraventricular tachycardia (24), ventricular tachycardia (26,27) or atrioventricular conduction block (28), myocardial stunning (29), transient ventricular dysfunction (30), syncope (24,27), or even sudden death (31,32). A number of diagnostic modalities have been used to investigate the anatomic and physiological significance of myocardial bridging (Table 1).
Myocardial bridging as a common phenotype of hypertrophic cardiomyopathy has no effect on prognosis
2014, American Journal of the Medical SciencesIncidence, clinical characteristics, and 4-year follow-up of patients with isolated myocardial bridge: A retrospective, single-center, epidemiologic, coronary arteriographic follow-up study in southern Turkey
2011, Cardiovascular Revascularization MedicineCitation Excerpt :The estimated frequency that has been reported varies from 1.5% to 16% when assessed by coronary angiography, but in some autopsy series, it is as high as 80% [10–13]. Traditionally, MB has been considered a benign condition, but the following complications have been reported: ischemia and acute coronary syndromes [14–18], coronary spasm [19], ventricular septal rupture [20], arrhythmias [21], exercise-induced atrioventricular conduction block [22], stunning [23], transient ventricular dysfunction [24], early death after cardiac transplantation [25], and sudden death [26]. In this trial, we aim to find the prevalence and prognosis of isolated MB patients who underwent coronary angiography for any reason as well as their clinical characteristics in the southern part of Turkey.
Myocardial bridging on dual-source computed tomography: degree of systolic compression of mural coronary artery correlating with length and depth of the myocardial bridge
2010, Clinical ImagingCitation Excerpt :The myocardial bridge can compress the tunneled segment and make the lumen narrow as a stenosis during the systolic phase; therefore, MB and MCA can be taken as a functional complex. In the past, MB was considered to be a normal anatomic variation, but many recent reports have implied that MB can impact the coronary flow and cause angina, myocardial infarction, life-threatening arrhythmias, and even sudden death [3–7]. The current gold standard for the detection of MB in vivo is conventional coronary angiography (CAG); however, its depiction rate is lower (0.5–16%) than that from autopsy (15–85%) [1,8,9].
Myocardial bridging as evaluated by 16 row MDCT
2009, European Journal of RadiologyCitation Excerpt :Despite the fact that it is a congenital anomaly, the patients are usually symptomless until the third decade [3]. Although this phenomenon has generally been considered a benign process, it may also cause myocardial ischemia, myocardial infarction, myocardial stunning, left ventricular dysfunction, ventricular septal rupture, premature death after cardiac transplantation, ventricular tachycardia and sudden cardiac death [6–14]. An autopsy study by Ferreira et al. classified MBs into two categories: superficial bridges (75% of cases) which cross the artery perpendicularly or at an acute angle toward the apex, and deep bridges in which muscle bundles arise from the right ventricular apical trabeculae (25% of cases) crossing the LAD transversely, obliquely, or helically before terminating in the interventricular septum [15].