Incidental Myocardial Bridging Coinciding With Myocardial Ischemia and Takotsubo Cardiomyopathy in an Asymptomatic Patient

Although most cases of myocardial bridging (MB) are clinically benign, it can sometimes be a risk factor for myocardial infarction (MI) and life-threatening arrhythmia. In this study, we present a case of MB-induced ST-segment elevation MI in a patient with stress cardiomyopathy. A 71-year-old man presented to the emergency department for evaluation of hepatic encephalopathy. The initial ECG was consistent with generalized ST elevation between leads 1, 2, 3, and V1-V6. Coronary angiography showed a segment of severe myocardial bridging in the mid-distal left anterior descending (LAD). Bridging caused almost complete beat-to-beat closure of the LAD, which was unchanged during coronary nicardipine administration. Myocardial bridging was treated medically with beta-blockers and calcium channel blockers. Echocardiography showed mild left ventricular systolic function deterioration, an ejection fraction of 35-40%, and apical ballooning consistent with stress cardiomyopathy. A repeat ECG several days later showed normal sinus rhythm and nonspecific T-wave abnormality. As our case report demonstrates, myocardial bridging and stress-induced cardiomyopathy can have significant clinical consequences and even manifest as acute coronary syndrome in certain clinical situations, which raises a compelling issue.