Coulibaly Sophie, Genet Thibaud, Bisson Arnaud, Bernard Anne, Ivanes Fabrice
Service de Cardiologie, Hôpital Trousseau, CHU de Tours, Avenue de la République, 37170 Chambray-Les-Tours, France.
UMR1327 ISCHEMIA Membrane Signalling and Inflammation in reperfusion injuries, Université de Tours, 10 Boulevard Tonnellé, 37032 Tours Cedex, France.
Eur Heart J Case Rep. 2024 Dec 24;9(1):ytae686. doi: 10.1093/ehjcr/ytae686. eCollection 2025 Jan.
Myocardial bridging (MB) is considered a frequent and benign condition. However, some patients may experience symptoms. The recent ESC guidelines on sports participation provide guidance on the management of these symptomatic patients with MB but do not provide guidance in the presence of another cardiac pathology.
A 14-year-old-male was admitted for ongoing chest pain and palpitations. He practiced rowing at a competitive level and had an episode of exercise-induced paroxysmal atrial fibrillation (AF) a month ago. A 12-lead electrocardiogram and biomarkers orientated toward an acute coronary syndrome. Transthoracic echocardiography was normal. Cardiac magnetic resonance imaging ruled out the hypothesis of myocarditis and showed no ischemic scar. A coronary computed tomography scan showed a significant MB of the left anterior descending coronary artery. We introduced a beta-blocker and monitored the absence of inducible ischaemia with an exercise echocardiography. Our conclusion was a myocardial infarction with non-obstructive coronary arteries due to MB and adrenergic AF. Return to rowing practice including competitions was allowed under beta-blocker therapy. The 6-year follow-up showed no recurrence of AF under treatment. The patient kept on training and competing, though at a lower level.
This atypical case demonstrates that the so-called benign MB may become malignant, in particular in conjunction with rapid non-physiologic heart rate, and that dealing with this abnormality in athletes remains difficult despite the latest guidelines. Safe return-to-play and competition remain, however, possible under medical therapy if the patient is asymptomatic and has no inducible ischaemia.
心肌桥（MB）被认为是一种常见的良性病症。然而，一些患者可能会出现症状。欧洲心脏病学会（ESC）近期发布的关于运动参与的指南为这些有症状的心肌桥患者的管理提供了指导，但在合并其他心脏病变的情况下未提供指导。
一名14岁男性因持续胸痛和心悸入院。他从事竞技水平的赛艇运动，一个月前曾有一次运动诱发的阵发性心房颤动（AF）发作。一份12导联心电图和针对急性冠状动脉综合征的生物标志物检测结果。经胸超声心动图检查正常。心脏磁共振成像排除了心肌炎的假设，且未显示缺血性瘢痕。冠状动脉计算机断层扫描显示左前降支冠状动脉有明显的心肌桥。我们引入了一种β受体阻滞剂，并通过运动超声心动图监测是否存在可诱导的缺血。我们的结论是，由于心肌桥和肾上腺素能性心房颤动导致非阻塞性冠状动脉心肌梗死。在β受体阻滞剂治疗下允许其恢复包括比赛在内的赛艇训练。6年随访显示治疗期间心房颤动未复发。患者继续训练和参赛，不过竞技水平有所降低。
这个非典型病例表明，所谓的良性心肌桥可能会变得恶性，特别是在伴有快速非生理性心率的情况下，并且尽管有最新指南，但处理运动员的这种异常情况仍然困难。然而，如果患者无症状且没有可诱导的缺血，在药物治疗下安全恢复运动和比赛仍然是可能的。
