Myocardial bridging mimicking Wellens’ syndrome
Brief Report

Myocardial bridging mimicking Wellens’ syndrome

Gustavo Lemos Pederçole, Marcos Danillo Peixoto Oliveira, Marcela Armelin Moritz, Renato Buchalla Barbar Cury, Adriano Caixeta

Department of Interventional Cardiology, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, Sao Paulo, SP, Brazil

Correspondence to: Marcos Danillo Peixoto Oliveira. Napoleão de Barros, nº 715 - Vila Clementino, Sao Paulo, SP 04024-002, Brazil. Email: mdmarcosdanillo@gmail.com.

Abstract: A myocardial bridging (MB) is a segment of an epicardial coronary that develops a transient intramyocardial course. Generally without repercussion, it may cause angina, arrhythmias, myocardial ischemia and even sudden cardiac death. We report herein an interesting case of a 60-year-old man presenting with type A Wellens’ syndrome due to a notorious mid left anterior descending MB.

Keywords: Myocardial bridging (MB); Wellens’ syndrome


Received: 04 January 2020; Accepted: 13 January 2020; Published: 25 March 2020.

doi: 10.21037/jxym.2020.01.01


A 60-year-old man presented to the emergency department complaining of recent onset angina at moderate efforts. The resting electrocardiogram (ECG) showed biphasic plus-minus T waves in the precordial leads, compatible with type A Wellens’ syndrome (Figure 1). The cardiac troponins sets were all negatives and resting cardiac echocardiogram was unremarkable. A recent coronary angiography revealed a mid-left anterior descending (LAD) myocardial bridging (MB) with massive systolic compression (Figure 2), without any significant lesions. After optimization of medical treatment (beta-blocker and calcium channel antagonist) the ECG pattern surprisingly changed (Figure 1).

Figure 1 Left panel: initial ECG showing type A Wellens’ sign in the precordial leads (white circles). Right panel: ECG showing resolution of the plus-minus T-waves pattern after optimal medical treatment. ECG, electrocardiogram.
Figure 2 Left anterior descending artery (cranial view). Left panel: diastolic phase. Right panel: significant systolic compression due to myocardial bridging (white arrow).

A MB is described as a segment of an epicardial coronary artery that develops a transient intramyocardial course. Generally without repercussion, it may cause angina, arrhythmias, myocardial ischemia and even sudden cardiac death. The burden of ischemia correlates directly with the degree of systolic compression. As in the present case, most MB is found in the mid LAD (1). First-line management for MB is optimal medical treatment with beta-blockers and calcium channel blockers, causing diastolic prolongation. Nitrates cause reflex tachycardia and are therefore contraindicated. In exceptional refractory cases, surgical or percutaneous strategies can be pursued (1,2).


Acknowledgments

None.


Footnote

Conflicts of Interest: The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.


References

  1. Ambesh P, Sharma D, Kapoor A, et al. Unusual Sign from an Unusual Cause: Wellens' Syndrome due to Myocardial Bridging. Case Rep Cardiol 2018;2018:3105653. [Crossref] [PubMed]
  2. Kaplanis I, Michas G, Arapi S, et al. Myocardial bridge as a cause of pseudo-Wellens' syndrome. Hellenic J Cardiol 2017;58:453-5. [Crossref] [PubMed]
doi: 10.21037/jxym.2020.01.01
Cite this article as: Pederçole GL, Oliveira MD, Moritz MA, Cury RB, Caixeta A. Myocardial bridging mimicking Wellens’ syndrome. J Xiangya Med 2020;5:6.