Rao Lakshmi, Chadha Arjun, Rao Anila, Khandavalli Anurag, Rao Surya
McLaren Macomb Medical Center, 1000 Harrington St, Mount Clemens, MI, 48043, USA.
AdventHealth Cardiovascular Institute, Port Orange, FL, USA.
Egypt Heart J. 2024 Oct 10;76(1):138. doi: 10.1186/s43044-024-00573-4.
Myocardial bridging (MB) is a known congenital anomaly in which a segment of the coronary artery transverses from the epicardium through the myocardium. MB may clinically manifest as recurrent angina, acute coronary syndrome, ventricular dysrhythmia, and even sudden cardiac death. On electrocardiogram (EKG), MB can present with findings consistent with significant ST-segment changes. The AngelMed Guardian System (the Guardian device) was developed in an effort to optimize the time from the onset of myocardial ischemia to intervention. The device analyzes myocardial electrical changes and alerts the patient to seek emergent medical evaluation if an acute ST-segment deviation is detected. We describe the first documented case of the Guardian device detecting acute ST-segment changes secondary to myocardial bridging.
A 50-year-old male, with a history of percutaneous coronary intervention of the proximal left anterior descending (LAD) artery, presented to his cardiologist's office with reports of recurrent, atypical chest pain. The Guardian device was implanted. One month after implantation, the patient experienced chest pain and was alerted by the Guardian device to seek emergent medical evaluation. Initial EKG and high-sensitivity troponins were negative for acute ischemia. Guardian device interrogation revealed significant ST depressions, encouraging further ischemic evaluation. The exercise myocardial perfusion imaging revealed an apical reversible defect. Left heart catheterization revealed a large segment of mid-LAD MB with the patient's previous LAD stent noted to be widely patent along with no evidence of new obstructive coronary disease. Following the identification of the MB, medication regimen adjusted and the patient denied recurrence of chest pain or Guardian alerts.
We describe the first documented case of the Guardian device detecting acute ST-segment changes that were secondary to myocardial bridging. The Guardian device appropriately documented an ischemic event not appreciated with initial EKG or troponin testing. With the assistance of the Guardian device, we were able to rapidly identify MB as the cause for the ischemic EKG changes and subsequent abnormal stress test, optimize medical management, and prevent recurrent atypical chest pain along with office and hospital visits.
心肌桥（MB）是一种已知的先天性异常，其中一段冠状动脉从心外膜穿过心肌。MB在临床上可能表现为反复发作的心绞痛、急性冠状动脉综合征、室性心律失常，甚至心源性猝死。在心电图（EKG）上，MB可表现出与明显ST段改变一致的表现。AngelMed Guardian系统（Guardian设备）的开发旨在优化从心肌缺血发作到干预的时间。该设备分析心肌电变化，并在检测到急性ST段偏差时提醒患者寻求紧急医疗评估。我们描述了Guardian设备检测到继发于心肌桥的急性ST段改变的首例记录病例。
一名50岁男性，有左前降支（LAD）近端经皮冠状动脉介入治疗史，因反复发作的非典型胸痛就诊于心脏病专家办公室。植入了Guardian设备。植入后一个月，患者出现胸痛，Guardian设备提醒其寻求紧急医疗评估。初始EKG和高敏肌钙蛋白检测未发现急性缺血。对Guardian设备的询问显示有明显的ST段压低，促使进一步进行缺血评估。运动心肌灌注成像显示心尖部可逆性缺损。左心导管检查显示LAD中段有一大段心肌桥，患者之前的LAD支架显示通畅，且无新的阻塞性冠状动脉疾病证据。在确定心肌桥后，调整了药物治疗方案，患者否认胸痛复发或收到Guardian设备的警报。
我们描述了Guardian设备检测到继发于心肌桥的急性ST段改变的首例记录病例。Guardian设备恰当地记录了一次初始EKG或肌钙蛋白检测未发现的缺血事件。在Guardian设备的帮助下，我们能够迅速确定心肌桥是缺血性EKG改变及随后异常负荷试验的原因，优化医疗管理，并预防反复发作的非典型胸痛以及减少门诊和住院次数。
