Atypical chest pain with non-specific ST changes: an incidental finding of myocardial bridge without flow limiting coronary lesion

Authors

  • Somesh Saha Department of Critical Care Medicine and Trauma Care, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
  • Aakash Guha Roy Department of Internal Medicine, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
  • Ritwick Mondal Department of Clinical Pharmacology and Therapeutic Medicine, IPGMER and SSKM Hospital, Kolkata, West Bengal, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20230896

Keywords:

Myocardial bridge, Angiography, Wall sheer stress, Dynamic ST changes

Abstract

Myocardial bridging is a developmental anomaly characterized by intramural course of a short segment of epicardial coronary artery which mostly remains silent in the initial few decades of life. A 42 years old male non diabetic, hypertensive on single regime therapy presented with atypical chest pain for the last two hours. Serial 12 lead ECGs on an interval of half-hour showing nonspecific dynamic ST changes in lead II, III and aVF suggesting of inferior wall changes with negative bio markers like troponin-T and troponin-I. Coronary angiography reveals myocardial bridge in mid segment of left anterior descending artery (LAD). Considering superficial type of bridging in this case, a conservative management strategy was planned accordingly. Physicians should be more vigilant on possibilities of underlying myocardial bridging as a major differential in emergency scenarios with low suspicion of atherosclerosis but with a picture equivalent to acute coronary syndrome (ACS). Myocardial bridge carries a wide array of complications depending on variabilities like depth of tunnelling, collapsibility, loss of wall sheer stress and vasospastic changes. Hence it needs to be promptly diagnosed with immediate treatment.

References

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Published

2023-03-29

How to Cite

Saha, S., Guha Roy, A., & Mondal, R. (2023). Atypical chest pain with non-specific ST changes: an incidental finding of myocardial bridge without flow limiting coronary lesion. International Journal of Research in Medical Sciences, 11(4), 1380–1382. https://doi.org/10.18203/2320-6012.ijrms20230896

Issue

Section

Case Reports