Clinical significance of isolated coronary bridges: Benign and frequent condition involving the left anterior descending artery

Kramer, John; Kitazume, Hidemasa; Proudfit, William L.; Sones, F. Mason

doi:10.1016/0002-8703(82)90500-2

Cited by 222 publications

(140 citation statements)

References 17 publications

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“…The frequency of MB ranges from 5.4% to 85% in autopsy series [2][3][4] and from 0.5% to 29.4% on coronary angiography [4][5][6][7][8][9][10] . It has been accepted that MB might affect the cardiovascular system [1,8,[11][12][13] .…”

Section: Introductionmentioning

confidence: 99%

Case of angina pectoris at rest and during effort due to coronary spasm and myocardial bridging

Teragawa

Fujii

Ueda

et al. 2015

WJC

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We present a case of a 71-year-old male who had chest symptoms at rest and during effort. He had felt chest oppression during effort for 1 year, and his chest symptoms had recently worsened. One month before admission he felt chest squeezing at rest in the early morning. He presented at our institution to evaluate his chest symptoms. Electrocardiography and echocardiography failed to show any specific changes. Because of the possibility that his chest symptoms were due to myocardial ischemia, he was admitted to our institution for coronary angiography (CAG). An initial CAG showed mild atherosclerotic changes in the proximal segment of the left anterior descending coronary artery (LAD) and mid-segment of the left circumflex coronary artery. Subsequent spasm provocation testing using acetylcholine revealed a bilateral coronary vasospasm, which was relieved after the intracoronary infusion of nitroglycerin. Finally, a CAG showed myocardial bridging (MB) of the mid-distal segments of the LAD. Fractional flow reserve using the intravenous administration of adenosine triphosphate was positive at 0.77, which jumped up to 0.90 through the myocardial bridging segments when the pressure wire was pulled back. Thus, coronary vasospasm and MB might have contributed to his chest symptoms at rest and during effort. Interventional cardiologists should consider the presence of MB as a potential cause of myocardial ischemia. Core tip: Myocardial bridging (MB), an anomaly in which the myocardium overlies the intramural course of segments of the epicardial coronary arteries, is associated with cardiac events. This may be explained by myocardial ischemia, coronary spasms, and/or mechanical compression of the coronary artery by the MB itself. We encountered a patient with angina pectoris both at rest and during exercise, which was caused by both coronary spasm and MB-induced direct myocardial ischemia. The latter finding was revealed using a pressure wire. MB sometimes causes two vascular characteristics, coronary spasms and direct myocardial ischemia, whose management is quite different.Teragawa H, Fujii Y, Ueda T, Murata D, Nomura S. Case of angina pectoris at rest and during effort due to coronary spasm and myocardial bridging.

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Section: Introductionmentioning

confidence: 99%

Case of angina pectoris at rest and during effort due to coronary spasm and myocardial bridging

Teragawa

Fujii

Ueda

et al. 2015

WJC

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“…[1][2][3] The frequency of MB has been reported to range from 5.4 to 85% in autopsy series [4][5][6] and from 0.5 to 29.4% on coronary angiography. 1,[6][7][8][9][10][11] Although it remains to be determined how MB affects the cardiovascular system, MB has been associated with myocardial infarction [12][13][14][15][16][17] and sudden cardiac death, [18][19][20][21] and coronary spasm is thought to be one factor connecting cardiac events and MB. 13,22,23 However, it has yet to be verified that coronary spasm is more frequent in patients with MB.…”

Section: Introductionmentioning

confidence: 99%

Myocardial bridging increases the risk of coronary spasm

Teragawa

Fukuda

Matsuda

et al. 2003

Clinical Cardiology

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SummaryBackground: Myocardial bridging (MB) has been associated with cardiac events. Whether coronary spasm is one factor contributing to those events is unknown.Hypothesis: This study investigated whether the likelihood of coronary spasm is increased in patients with MB.Methods: A spasm-provocation test was performed by infusing acetylcholine into the left coronary artery in 114 Japanese patients with chest pain. The test result was defined as positive when the diameter of the coronary artery was reduced by ≥ 50% and ST-segment changes were documented. Myocardial bridging was defined as a > 15% reduction in coronary arterial diameter during systole after intracoronary injection of nitroglycerin.Results: Myocardial bridging was identified in 41 patients (36%) and was located in the mid-segment of the left anterior descending coronary artery (LAD) in all patients. Patients with MB experienced coronary spasm more frequently than patients without MB (MB+: 73%; MBϪ: 40%, p = 0.0006). Furthermore, among patients with a positive spasm-provocation test, coronary spasm occurred more frequently in the midsegment of the LAD in patients with MB than in those without MB (MB+: 73%; MBϪ: 45%, p = 0.0259). Multivariate regression analysis demonstrated that MB was a predictor of coronary spasm (odds ratio: 3.478, p = 0.0088).

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“…Myocardial bridging of the coronary arteries is a frequent congenital anomaly, detected in 15% to 85% of autopsy series and in 0.5% to 16% of angiographic studies (1)(2)(3)(4)(5). Although myocardial bridging is generally considered as a harmless clinical anomaly, several reports have showed an association of this condition with sudden cardiac death (6), myocardial infarction (7,8), coronary artery spasm (9) or ventricular arrhythmia (10).…”

Section: Introductionmentioning

confidence: 99%

Acute Myocardial Infarction Associated with Myocardial Bridging in a Young Adult

et al. 2004

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A 28-year-old man was admitted because of chest pain. Emergency coronary angiography showed a massive thrombus in the proximal segment and another occlusive thrombus in the distal segment of the left anterior descending artery. He was treated with thrombolytic therapy. Repeat coronary angiography showed disappearance of the thrombi in the proximal and distal segments and obvious myocardial bridging in the mid segment. Intravascular ultrasound revealed an atherosclerotic plaque in the segment immediately proximal to the myocardial bridging, but did not reveal any plaque within or distal to the site. He was discharged 12 days later.

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Clinical significance of isolated coronary bridges: Benign and frequent condition involving the left anterior descending artery

Cited by 222 publications

References 17 publications

Case of angina pectoris at rest and during effort due to coronary spasm and myocardial bridging

Case of angina pectoris at rest and during effort due to coronary spasm and myocardial bridging

Myocardial bridging increases the risk of coronary spasm

Acute Myocardial Infarction Associated with Myocardial Bridging in a Young Adult

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