Myocardial bridging presenting as myocardial ischaemia induced cardiac arrest: a case report

Abstract

Background Myocardial bridging is a congenital anomaly defined as a segment of epicardial coronary arteries running through the myocardium. Various complications related to myocardial bridging have been reported, but at present, cardiac arrest has rarely been reported. Case presentation We report one case of a patient who was successfully resuscitated from ventricular fibrillation cardiac arrest and was diagnosed with myocardial bridging accompanied by myocardial ischaemia. A 50-year-old woman who had been resuscitated from cardiac arrest transferred to our institution for evaluation and management of out-of-hospital cardiac arrest. We confirmed the diagnosis of significant myocardial bridging with evident myocardial ischaemia by coronary angiography, resting echocardiography and heart MRI. Vasospasm was thought to be a trigger factor judging from the transient ST elevation on electrocardiography. In addition, the finding of septal buckling was detected for the first time throughout the whole cardiac cycle by resting echocardiography in MB. Conclusion We report a rare case of survival after out-of-hospital cardiac arrest that might be caused by significant myocardial bridging-induced myocardial ischaemia, which was objectively confirmed by echocardiography and heart MRI. Although myocardial bridging is often overlooked as an aetiology for sudden cardiac death, this case highlights the importance of expanding the differential diagnosis to myocardial bridging in the work-up for the cause of sudden cardiac death.

Case report: A fatal case of myocardial infarction due to myocardial bridge and concomitant vasospasm: the role of stress gated SPECT

“…Since most patients with MBs have no clinical symptoms, many clinicians are reluctant to manage it with intensive medical treatments then just tend to recommend simple observation with not much clinical significance. Although most cases with MBs are clinically benign ( 7 ), as suggested in the present case, sometimes it can be one of potential threats of MI and life-threatening arrhythmia ( 9 , 10 ). According to an observational retrospective study, MB seems to be a potential cause of MI, and its prevalence was significantly higher in patients with MINOCA than in their counterparts ( 10 ).…”

“…In other words, MB may contribute to the development of acute coronary syndrome such as myocardial infarction (MI) or cardiac arrest ( 5 – 7 ). Especially, coronary vasospasm (CVS) may act as a trigger factor for these situations in patients with MB ( 7 ). We present a case of ST-segment elevation MI triggered by CVS within the site of MB.…”

Clinical Outcomes of Surgical Treatment on Myocardial Bridging in Symptomatic Patients Running Title: Surgical treatment outcomes of myocardial bridging

“…In recent years, some researchers have considered MBs to be an independent risk factor for coronary atherosclerosis 6 . It has been reported that vasospasm caused by MBs may not only be the cause of myocardial ischemia and ventricular brillation and cardiac arrest but also lead to myocardial brosis, contractile band necrosis, and increased vascular density, which is closely related to myocardial insu ciency, angina pectoris, acute myocardial infarction and malignant arrhythmia 7,8 . Biomechanical changes caused by MBs are also the basis of its complications, such as plaque vulnerability, thrombosis, and vasospasm.…”

Myopericarditis After BNT162b2 mRNA Vaccination With Incidental Intramyocardial Bridging

“…On the other hand, the angiographic prevalence of MB was reported as 5% [18]. Although MB has been reported to be associated with acute coronary syndrome in many studies, no definite pathologic correlation between MB and acute coronary syndrome has been clearly established and it is generally considered a benign condition [19,20].…”