Challenge in Diagnosis and Management of a Patient With Myocardial Bridge and Coronary Artery Spasm

Isn’t It All Quotidian Endothelial Dysfunction?

“…This 69-year-old ex-smoker has hyperlipidemia, diabetes, and hypertension. The coronary angiogram shows widespread small-vessel disease without convincing angiographic myocardial bridging; neither does the intravascular ultrasound (IVUS) reveal systolic luminal constriction (as seen in Figure 4B of Ha et al 1 ). The positive nuclear stress test is not surprising given the context, but it is a stretch to match this with diagonal and septal ischemia caused by coronary steal from a myocardial bridge not visible within the vicinity of these side branches.…”

“…The pareidolic attempt of Ha et al 1 to link ischemia with nonobstructive coronary arteries (INOCA) with myocardial bridging and vasospastic angina is worthy of further examination. This 69-year-old ex-smoker has hyperlipidemia, diabetes, and hypertension.…”