Severe Myocardial Bridging-Induced Total Occlusion of the Left Anterior Descending (LAD) Artery Mimicking Wellens’ Syndrome: A Case Report

This case report describes a 66-year-old male with a three-month history of exertional chest pain that progressed from New York Heart Association (NYHA) class 2 to class 3 within one week, raising clinical concerns despite an unclear trigger. ECG findings showed biphasic T waves in leads V2 and V3 and T-wave inversions in leads V4 to V6, resembling the pattern seen in Wellens' syndrome, which typically suggests critical left anterior descending (LAD) artery stenosis. However, initial assessments showed no significant atherosclerosis - a notable finding given the usual association of Wellens' syndrome with atherosclerotic disease and its rarity in congenital anomalies. Coronary angiography and cardiac CT imaging revealed a severe myocardial bridge in the mid to distal LAD artery, leading to complete occlusion with preserved blood flow through a diagonal branch. These imaging modalities were essential for confirming the diagnosis by clearly depicting the extent of myocardial bridging and collateral circulation. This case underscores the importance of considering congenital anomalies, such as myocardial bridging, in the differential diagnosis of acute coronary syndromes, even when atherosclerosis is absent. Early recognition of these abnormalities is vital to ensure appropriate intervention and to prevent misdiagnosis.