DOI: 10.36347/sjmcr.2022.v10i09.024

Pages: 961-966

Introduction: Myocardial bridging (MB) is a congenital coronary artery malformation. Various clinical symptoms related to MB have been reported; however, subxiphoid pain has rarely been reported. Moreover, it is rarer for electrocardiography (ECG) to show such obvious ischaemia in patients with MB. Objectve: To report the case of a 65- year-old patient in whom the diagnosis was made during coronary angiography, and whose management was pharmacological with good progress. Case Report: The patient was 65 years old, with no cardiovascular risk factors other than age and male gender, a former smoker with 20 BPs, admitted to our clinic for management of stress angina that had been present for 3 years prior to his admission, associated with NYHA stage II dyspnea. On admission, the patient was conscious, hemodynamically and respiratory stable, with no signs of right or left heart failure. The ECG was in regular sinus rhythm, with negative T waves in septo-apical, extended to the right leads. Troponin was positive at 110ng/l. TTE was performed showing a non-dilated, non-hypertrophied LV with preserved systolic function LVEF at 72%, preserved segmental and global kinetics, non-dilated atria free of echoes, absence of significant mitro-aortic valve disease, LV size and longitudinal systolic function preserved. A coronary angiography was performed showing a Milking aspect of the anterior interventricular artery, associated with coronary-ventricular fistulas, without significant atheromatous lesions. Discussion and Conclusion: The myocardial bridge corresponds to a coronary anomaly, most often congenital, in its anatomical relationship to the myocardial muscle, which more frequently affects the anterior interventricular artery. Despite technical advances, angiography remains the reference diagnostic method with a typical image of milking systolic compression. In most cases benign and asymptomatic, it can nevertheless be responsible for serious and even fatal complications. ....