Abdou Mohamed
Cardiology Department, Zagazig Faculty of Medicine, Zagazig, Egypt.
Int Arch Med. 2011 Jul 7;4:24. doi: 10.1186/1755-7682-4-24.
Myocardial bridging is present when a segment of a major epicardial coronary artery runs intramurally through the myocardium. It usually has a benign prognosis, but in some cases myocardial ischemia, infarction and sudden cardiac death have been reported. We are here reporting a case of myocardial bridging which was complicated with recurrent chest pain and transient ST-segment elevation during exercise treadmill test.
A 40 year-old-man presented with recurrent retrosternal chest pain of 2 months duration. He had history of smoking and was obese, otherwise no physical abnormalities were detected by examination. Electrocardiogram and blood tests were normal apart from impaired glucose tolerance with elevated triglycerides and decreased level of high density lipoprotein cholesterol. While doing exercise treadmill test, the patient developed chest pain and significant ST-segment elevation in almost all precordial leads that persisted for about 15 minutes through recovery. We decided to admit the patient to the coronary care unit for further management and to perform coronary angiogram. Myocardial bridging was observed in the mid segment of the left anterior descending coronary artery. Medical treatment was decided.At one year follow up, our patient was healthy and had no cardiac complaints. In conclusion, myocardial bridging may predispose to coronary vasospasm that may leads to ischemic complications.
当一段主要的心外膜冠状动脉走行于心肌内时，即存在心肌桥。其通常预后良好，但在某些情况下，曾有心肌缺血、梗死及心源性猝死的报道。我们在此报告一例心肌桥病例，该病例在运动平板试验期间并发反复胸痛及短暂性ST段抬高。
一名40岁男性，出现持续2个月的反复胸骨后胸痛。他有吸烟史且肥胖，除此之外，体格检查未发现异常。心电图和血液检查正常，但存在糖耐量受损、甘油三酯升高及高密度脂蛋白胆固醇水平降低。在进行运动平板试验时，患者出现胸痛，几乎所有胸前导联均有明显的ST段抬高，该情况在恢复过程中持续约15分钟。我们决定将患者收入冠心病监护病房进行进一步治疗并进行冠状动脉造影。在左前降支冠状动脉中段观察到心肌桥。决定进行药物治疗。在一年的随访中，我们的患者身体健康，无心脏不适主诉。总之，心肌桥可能易引发冠状动脉痉挛，进而导致缺血性并发症。
