SHM Converge Scientific Abstract ePoster Gallery-Bridging the Gap: Myocardial Bridge as an Important Differential Diagnosis

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This case describes a 48-year-old woman with Hashimoto’s thyroiditis, prediabetes, and active tobacco use who developed severe chest pain after an intense workout. She presented hypotensive and diaphoretic with ST elevations on EKG and markedly elevated troponins, raising concern for acute myocardial infarction. However, coronary angiography showed no obstructive coronary artery disease, but did reveal a large myocardial bridge. Transthoracic echocardiography demonstrated severe left ventricular dysfunction with apical akinesis and ballooning consistent with Takotsubo cardiomyopathy, along with systolic anterior motion of the mitral valve, left ventricular outflow tract obstruction, and an apical LV mural thrombus.<br /><br />Her hospital course was complicated by hemodynamic instability requiring inotropic and vasopressor support, as well as esmolol. She was ultimately discharged on metoprolol, anticoagulation, and guideline-directed medical therapy for Takotsubo cardiomyopathy. Follow-up cardiac MRI three days later showed improved ejection fraction, and by three months her cardiac function had normalized with resolution of the thrombus and Takotsubo findings. She also quit smoking and adopted healthier lifestyle habits.<br /><br />The report emphasizes that myocardial bridge, once thought to be a benign anatomical variant, can cause significant ischemia and may be an important differential diagnosis in patients with chest pain and elevated cardiac biomarkers. Management typically includes beta blockers and sometimes calcium channel blockers, while nitrates should be avoided because they can worsen vessel compression. In severe cases, surgical options may be needed. The authors suggest that myocardial bridge may play a role in triggering Takotsubo cardiomyopathy, especially when the LAD is involved, and call for further research into this relationship.

Asset Subtitle

Aphrodite Megaris

Meta Tag

Author List Amit Gulati, Aphrodite Megaris, Faye Megaris, Mariam Khandaker

Category Clinical Vignettes

Concept Myocardial Bridge

Concept Beta Blocker

Concept Nonobstructive Coronary Arteries

Concept Ischemia

Concept Left Ventricular Dysfunction

Distinguished Non-Finalist

Presenter Organization Icahn School of Medicine at Mount Sinai - New York

Presenting Author Aphrodite Megaris

Track Adult

Keywords

Takotsubo cardiomyopathy

myocardial bridge

acute myocardial infarction

ST elevation

troponin elevation

left ventricular dysfunction

apical akinesis

left ventricular outflow tract obstruction

beta blocker therapy

coronary angiography

Myocardial Bridge

Beta Blocker

Nonobstructive Coronary Arteries

Ischemia

Left Ventricular Dysfunction