Case report: an unexpected case of minoca in a 56-year-old male with myocardial bridge
Arq. bras. cardiol
; Arq. bras. cardiol;119(4 supl.1): 249-249, Oct, 2022.
Article
em En
| CONASS, SES-SP, SESSP-IDPCPROD, SES-SP
| ID: biblio-1397446
Biblioteca responsável:
BR79.1
ABSTRACT
INTRODUCTION:
A myocardial bridge (MB) is typically asymptomatic, but sometimes can lead to a myocardial infarction with several mechanisms such as coronary spasm, thrombosis, coronary dissection, or the development of focal atherosclerosis immediately proximal to the MB. Sometimes more than one mechanism can be present. The use of intracoronary images modalities, as Optical Coherence Tomography (OCT) in patient with MB can accurately define the mechanism of the myocardial infarction and provide further guidance to management strategy. CASE REPORT 56-yearold male with past medical history of systemic arterial hypertension and active tobacco use, attended the emergency department with severe oppressive chest pain after a long car trip in the heat. The initial electrocardiogram showed ST-elevation in anterior leads. Coronary angiography revealed a myocardial bridge with a systolic constriction of more than 90% in the proximal third of the left anterior descending artery (LAD), OCT demonstrate a lesion < 20% with no signs of rupture. The patient was diagnosed with MINOCA with multiple mechanisms such as supply and demand imbalance, cigarette-induced vasospasm and hypovolemia. The patient was treated with beta blockers and antiplatelet therapy and discharged 3 days later. There was no recurrence of chest pain at follow-up appointments.CONCLUSION:
Myocardial bridge (MB) is a congenital anatomic anomaly whereby a length of the artery tunnels beneath a section of myocardium. It can potentially be associated with phasic arterial spasm and ischemia. About 67-98% of cases have their anatomical location in the LAD. The gold standard for diagnosis is autopsy, but angiography and OCT provides more information about MBs, such as assessment of vulnerable plaque and coronary morphology. Unlike classic atherosclerotic plaque that produces a fixed stenosis, MB produces a dynamic effect that varies with cardiac cycle, heart rate, and sympathetic tone. According to the classification by Schwarz 2009, this case is classified as type C, with altered intracoronary hemodynamics. The clinical management was maintained with pharmacological therapy, which is the mainstay treatment. Angioplasty would be suggested only for cases with refractory symptoms. The patient was conducted with medications for management of heart failure and general orientation, with no recurrence of chest pain.
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Coleções:
06-national
/
BR
Base de dados:
CONASS
/
SES-SP
/
SESSP-IDPCPROD
Assunto principal:
Placa Aterosclerótica
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MINOCA
Tipo de estudo:
Guideline
Idioma:
En
Revista:
Arq. bras. cardiol
Ano de publicação:
2022
Tipo de documento:
Article
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Congress and conference