World J Cardiol. 2015 Jun 26;7(6):367-72. doi: 10.4330/wjc.v7.i6.367.

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

World journal of cardiology

Hiroki Teragawa, Yuichi Fujii, Tomohiro Ueda, Daiki Murata, Shuichi Nomura

PMID: 26131343 PMCID: PMC4478573 DOI: 10.4330/wjc.v7.i6.367

Abstract

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.

Keywords: Coronary spasm; Fractional flow reserve; Myocardial bridging; Myocardial squeezing

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