Severe myocardial bridge presenting as paroxysmal atrioventricular block

Abstract

Chest pain complicated with electrocardiographic changes is not an uncommon scenario in emergency departments, which should be examined cautiously. We describe a 51-years-old man with a myocardial bridge of coronary artery presenting with simultaneous Mobitz type I atrioventricular block on electrocardiography. Echocardiography excluded valvular abnormality and systolic/diastolic dysfunction. Coronary angiography confirmed the diagnosis of a myocardial bridge at the middle segment of the left anterior descending artery, involving the most dominant septal perforator branch with marked systolic compression. The patient underwent coronary artery bypass grafting surgery and was followed up uneventfully at the outpatient department with medical treatment of diltiazem and clopidogrel. The present case is being reported to highlight that clinicians should be alert to such a congenital abnormality as a potential cause of repeated myocardial infarction and conduction abnormality.

Myocardial Bridging-Induced Acute Coronary Syndrome: A Bridge Too Far

“…Electrocardiographic changes are frequent, but there are reported cases of pseudo-Wellens’ (biphasic T-waves or deep T-wave inversions in leads V2 and V3), VF, transient STE, and atrioventricular block [ 9 , 11 , 16 , 17 ]. Echocardiographic findings have revealed an abnormal left ventricular strain pattern, diastolic dysfunction, myocardial stunning, and SRC.…”

A Young Adult With Myocardial Bridging: A Case Report

“…Though any coronary artery can be involved in MB, the studies showed that the left anterior descending artery is most commonly involved in MB. In contrast, the left circumflex and right coronary arteries are rarely affected [ 6 ].…”

A Case of Symptomatic Myocardial Bridge Treated with Calcium Channel Blocker

“… 9 The rare presentation of coronary artery aneurysm combined with myocardial bridge was also reported by Ye et al 10 In addition, MB was reported with atrioventricular block which is a potential cause of repeated myocardial infarction and conduction abnormality. 8 MB has mostly been reported at autopsy. MB-induced myocardial ischemia has rarely been reported in a live individual.…”