Article Text
Summary
A 50-year-old man with a history of vasospastic angina diagnosed 3 months prior presented with recurrent episodes of substernal chest pain. His chest pain was characterised as ‘squeezing’, lasting 10 min and typically occurred on awakening. Medications included isosorbide, nitroglycerin and ranolazine; however, due to lack of insurance he was unable to obtain these medications. On admission, patient was given a full-dose aspirin and nitroglycerin, which acutely worsened his chest pain. ECG did not reveal ischaemic changes and initial troponin was negative. A left heart catheterisation was conducted, revealing a myocardial bridge of the mid-left anterior descending artery. Myocardial bridge, due to its rarity, is often overlooked as an aetiology for angina, myocardial ischaemia, acute coronary syndrome, syncope and cardiac death. This case highlights the importance of broadening the differential to include myocardial bridge in the work-up for chest pain, especially if nitrates worsen symptoms.
- interventional cardiology
- ischaemic heart disease
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Footnotes
Contributors MP and BS contributed equally to the planning, literature review, conception, design, analysis and review of the manuscript. ED provided critical review and editing of the manuscript.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.