Qin Zhilu, Lv He, Ren Zengduoji, Li Xinyu, Fu Chunying, Fu Qiang
Department of Cardiology, The People's Hospital of Liaoning Province, Wenyi Road, Shenhe, Shenyang, Liaoning, 110016, China.
BMC Cardiovasc Disord. 2024 Aug 8;24(1):412. doi: 10.1186/s12872-024-04069-6.
Clinical events such as angina pectoris, acute coronary syndrome, and sudden death caused by myocardial bridge (MB) have attracted increasing attention. It is still a challenge to diagnose whether MB can cause the symptoms of patients with MB. For most MB patients, medication remains the primary treatment.
This article reports a case of chest pain in a patient with MB in the middle segment of the left anterior descending artery (LAD) with moderate stenosis in the proximal segment (LAD). Through functional assessment, we found that neither MB nor fixed stenosis had sufficient effect on coronary blood flow to cause myocardial ischemia, but their synergistic effect resulted in myocardial ischemia. Finally, a stent was implanted in LAD and good clinical results were achieved.
For symptomatic patients with MB combined with fixed stenosis, functional evaluation may be necessary, which has significant guiding significance for treatment strategy selection. For asymptomatic patients, early detection of myocardial ischemia may also improve the prognosis of patients.
心肌桥(MB)所致的心绞痛、急性冠状动脉综合征及猝死等临床事件已引起越来越多的关注。诊断MB是否会引发患者症状仍是一项挑战。对于大多数MB患者,药物治疗仍是主要治疗方式。
本文报道1例左前降支(LAD)中段MB患者,其LAD近端存在中度狭窄,表现为胸痛。通过功能评估,我们发现MB和固定狭窄单独对冠状动脉血流均无足够影响以导致心肌缺血,但二者的协同作用导致了心肌缺血。最终,在LAD植入支架,取得了良好的临床效果。
对于有症状的MB合并固定狭窄患者,可能需要进行功能评估,这对治疗策略的选择具有重要指导意义。对于无症状患者,早期发现心肌缺血也可能改善患者预后。