Myocardial bridging as a cause of cardiac ailments – genetics?

    Authors

    Keywords

    myocardial bridging, ischemia, coronary CT angiography, genetics, palpitations

    DOI

    https://doi.org/10.15836/ccar2016.479

    Full Text

    Myocardial bridging (MB) is an anatomical anomaly which is increasingly detected using coronary CT angiography (CCTA). The clinical significance of MB has been still insufficiently explored, moreover there are descriptions of this phenomenon in association with acute coronary syndrome, a variety of rhythm disorders and sudden deaths. After the breakthrough of the invasive coronary angiography (ICA), at which the so-called “milking”-effect may be observed, most commonly in the middle segment of the left anterior descending artery (LAD), in vivo diagnosis could be established. However, the ICA diagnosis showed a great discrepancy compared to post mortem diagnosis in this matter. According to some data, MB-prevalence is up to 50% (CCTA), as well as on autopsy studies, while at ICA this phenomenon has been observed in merely 5-10% of all cases. The presented case refers to a family, with both a father (56) and a son (26) being diagnosed with MB. They both had an unexplained recurrent thoracic pain i.e. palpitations. Thus, the son felt a sharp pain in the right chest whereby the pain spread in the mediastinum, across the right shoulder and the right side of the neck. In addition, he complained of paraesthesia in his extremities during physical activity. As regards his family medical history, on his mother’s side there were some cases of heart diseases. Patient’s general health status was normal. There were no signs of heart failure with a blood pressure of 140/80 mmHg. The standardized ECG in the emergency room was within normal ranges. Lab tests were within normal ranges, as well as chest X-ray. Both neurological and multiple cardiological examinations and findings were normal. The pain in the chest with a normal echocardiography led also to CCTA of the father and subsequently of the son. Shallow MB of the middle and distal LAD has been found in both patients. Additionally, insignificant plaques have been found in the LAD of the father (**Figures 1****,****2****,****3****,****4** and **5**). Both patients are stable under beta-blockers. In summary, we regard these symptoms to be associated with MB. Figure 1. Comparison of the myocardial bridging respectively atherosclerotic lesions of father and son. Figure 2. Calcified plaques in the proximal segment and myocardial bridging of the middle and distal part of the left anterior descending artery (father). Figure 3. Non-calcified plaques in the proximal segment and myocardial bridging of the middle and distal part of the left anterior descending artery (father). Figure 4. Myocardial bridging of the middle and distal part of the left anterior descending artery without atherosclerosis (son). Figure 5. Myocardial bridging of the middle and distal part of the left anterior descending artery without atherosclerosis (son). Owing to the collected data (1-3), we may conclude that MB should also be considered in association with cardiac symptoms that otherwise cannot be explained. The genetic basis of MB in certain families remains a topic of future research.

    Literature

    1. Jukić M. Uloga višeslojne kompjutorizirane tomografije u dijagnostici i procjeni kliničke važnosti koronarnih arterija intramiokardnoga tijeka [dizertacija]. Medicinski fakultet Sveučilišta u Zagrebu, Medicinski fakultet, 2016.
    2. Yamada R, Tremmel JA, Tanaka S, Lin S, Kobayashi Y, Hollak MB, et al. Functional Versus Anatomic Assessment of Myocardial Bridging by Intravascular Ultrasound: Impact of Arterial Compression on Proximal Atherosclerotic Plaque. J Am Heart Assoc. 2016;5(4):e001735. https://doi.org/10.1161/JAHA.114.001735
    3. Van De Wiele C, Rimbu A, Belhocine T, DeSpiegeleer B, Sathekge M, Maes A. Reversible mycordial perfusion defects in patients not suffering from obstructive epicardial coronary artery disease as assessed by coronary angiography: a review of the literature. Q J Nucl Med Mol Imaging. 2016 Mar 23; [Epub ahead of print]. https://pubmed.ncbi.nlm.nih.gov/27007665/
    Cardiologia Croatica
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    Myocardial bridging as a cause of cardiac ailments – genetics?

    Extended Abstract
    Issue10-11
    Published
    Pages479-480
    PDF via DOIhttps://doi.org/10.15836/ccar2016.479
    myocardial bridging
    ischemia
    coronary CT angiography
    genetics
    palpitations

    Authors

    Dorijan Jagačić*ORCIDSunce Clinic, Zagreb, Croatia
    Ladislav PavićORCIDSunce Clinic, Zagreb, Croatia
    Petar MedakovićORCIDSunce Clinic, Zagreb, Croatia
    Kata ĆorićORCIDSunce Clinic, Zagreb, Croatia
    Dražen LovrićORCIDSunce Clinic, Zagreb, Croatia
    Mladen JukićORCIDSunce Clinic, Zagreb, Croatia

    *Correspondence email: djagacic@inet.hr

    Full Text

    Myocardial bridging (MB) is an anatomical anomaly which is increasingly detected using coronary CT angiography (CCTA). The clinical significance of MB has been still insufficiently explored, moreover there are descriptions of this phenomenon in association with acute coronary syndrome, a variety of rhythm disorders and sudden deaths. After the breakthrough of the invasive coronary angiography (ICA), at which the so-called “milking”-effect may be observed, most commonly in the middle segment of the left anterior descending artery (LAD), in vivo diagnosis could be established. However, the ICA diagnosis showed a great discrepancy compared to post mortem diagnosis in this matter. According to some data, MB-prevalence is up to 50% (CCTA), as well as on autopsy studies, while at ICA this phenomenon has been observed in merely 5-10% of all cases.

    The presented case refers to a family, with both a father (56) and a son (26) being diagnosed with MB. They both had an unexplained recurrent thoracic pain i.e. palpitations. Thus, the son felt a sharp pain in the right chest whereby the pain spread in the mediastinum, across the right shoulder and the right side of the neck. In addition, he complained of paraesthesia in his extremities during physical activity. As regards his family medical history, on his mother’s side there were some cases of heart diseases. Patient’s general health status was normal. There were no signs of heart failure with a blood pressure of 140/80 mmHg. The standardized ECG in the emergency room was within normal ranges. Lab tests were within normal ranges, as well as chest X-ray. Both neurological and multiple cardiological examinations and findings were normal. The pain in the chest with a normal echocardiography led also to CCTA of the father and subsequently of the son. Shallow MB of the middle and distal LAD has been found in both patients. Additionally, insignificant plaques have been found in the LAD of the father (Figures 1,2,3,4 and 5). Both patients are stable under beta-blockers. In summary, we regard these symptoms to be associated with MB.

    Figure 1. Comparison of the myocardial bridging respectively atherosclerotic lesions of father and son.

    Figure 2. Calcified plaques in the proximal segment and myocardial bridging of the middle and distal part of the left anterior descending artery (father).

    Figure 3. Non-calcified plaques in the proximal segment and myocardial bridging of the middle and distal part of the left anterior descending artery (father).

    Figure 4. Myocardial bridging of the middle and distal part of the left anterior descending artery without atherosclerosis (son).

    Figure 5. Myocardial bridging of the middle and distal part of the left anterior descending artery without atherosclerosis (son).

    Owing to the collected data (1–3), we may conclude that MB should also be considered in association with cardiac symptoms that otherwise cannot be explained. The genetic basis of MB in certain families remains a topic of future research.

    Literature

    1. 1.
      Jukić M. Uloga višeslojne kompjutorizirane tomografije u dijagnostici i procjeni kliničke važnosti koronarnih arterija intramiokardnoga tijeka [dizertacija]. Medicinski fakultet Sveučilišta u Zagrebu, Medicinski fakultet, 2016.
    2. 2.
      Yamada R, Tremmel JA, Tanaka S, Lin S, Kobayashi Y, Hollak MB, et al. Functional Versus Anatomic Assessment of Myocardial Bridging by Intravascular Ultrasound: Impact of Arterial Compression on Proximal Atherosclerotic Plaque. J Am Heart Assoc. 2016;5(4):e001735.DOI
    3. 3.
      Van De Wiele C, Rimbu A, Belhocine T, DeSpiegeleer B, Sathekge M, Maes A. Reversible mycordial perfusion defects in patients not suffering from obstructive epicardial coronary artery disease as assessed by coronary angiography: a review of the literature. Q J Nucl Med Mol Imaging. 2016 Mar 23; [Epub ahead of print].PubMed