Myocardial bridging manifested as acute coronary syndrome: an unusual presentation of the so-called benign coronary anatomy variant

Abstract

Myocardial bridging is an anatomical variant characterized by a coronary artery that tunneled through the myocardium. Often asymptomatic, myocardial bridging could also go to a further extent, presenting as myocardial ischemia in the form of stable angina pectoris, acute coronary syndrome, arrhythmias, or even sudden cardiac death. Although these are uncommon manifestations, it is still a challenge for physicians when encountering such cases. Additional imaging techniques are often required to diagnose myocardial bridging. This report is about a unique case of a 72-year-old man presenting with acute coronary syndrome (ACS) in the form of unstable angina pectoris (UAP), which was later found to be caused by myocardial bridging on coronary angiography. Following administration of beta-blocker, antiplatelet, and statin, the angina symptoms, as well as ischemic sign on electrocardiography (ECG), were completely resolved.