A Case of Myocardial Infarction in a Patient with Myocardial Bridge and Atrial Fibrillation

ABSTRACT

It has been reported that myocardial bridging may be associated with myocardial ischemia, myocardial infarction, vasospasm, cardiac arrhythmia and sudden death. However, the mechanism whereby ischemia occur as a consequence of myocardial bridging remains unclear. Recently we experienced a case of myocardial infarction in a patient with myocardial bridging and atrial fibrillation. A 66-year-old man presented with severe chest pain. His ECG showed ST elevation in V3-V5 and atrial fibrillation with rapid ventricular response. He underwent coronary angiography, which revealed a thrombus in the distal portion of the myocardial LAD bridge. He was treated with antiplatelet agents, heparin, tirofiban and amiodarone and beta-blocker without percutaneous coronary intervention. Five days later, his clinical condition was recovered and follow-up coronary angiography revealed markedly improved blood flow of the left anterior descending artery. The previous thrombus had disappeared.