MyocardiaI Infarction in Young Patient on Myocardial Bridge Revealed by Ventricular Arrhythmia: A Case Report

Background: Myocardial bridging (MB) is a congenital coronary anomaly with normal coronary epicardial artery taking an intra myocardial pathway also described as tunneled artery. This benign anatomical abnormality usually can manifest as an acute coronary syndrome or fatal ventricular arrhythmia.

Methods: We present an unusual case of a young male patient with a history of MI on MB who presented at the emergency room for constrictive retro sternal chest pain associated with palpitations evolving for 24 hours with ventricular tachycardia on the ECG reduced by pharmacological therapy. Coronary angiography showed a myocardial bridging at the level of the distal left interventricular artery without atheromatous lesions neither in the upstream or downstream of the vascular bed nor in the other coronary networks. Cardiac MRI findings showed a predominantly left biventricular dilated cardiomyopathy of ischemic origin with severe LV dysfunction.

Discussion: MB can be associated with serious manifestations such as syncope, myocardial ischemia, coronary spasm, supraventricular or ventricular arrhythmias, atrioventricular block, exceptionally a coronary syndrome or even sudden death. Our case is one of the rare case reports of MB manifested as myocardial ischemia complicated with ventricular arrhythmias in a young patient without an evident cardiovascular risk factor.

Conclusion: Management decision on myocardial bridge remains controversial but medical therapy consist of the first therapeutic line. This is a case of a complicated myocardial bridge with a proof of effectiveness of medical therapy.