Recurrent Angina in Apical Hypertrophic Cardiomyopathy Associated With Myocardial Bridging of the Posterior Descending Artery

Chest pain with apical hypertrophic cardiomyopathy (HCM) warrants concern for acute coronary syndrome (ACS). When obstructive coronary disease is excluded, myocardial bridging should remain an important consideration. We report a 60-year-old female with apical HCM and multiple prior evaluations for a mix of typical and atypical chest pain who presented with worsening dyspnea on exertion and stable intermittent chest pain. Coronary angiography revealed a myocardial bridge involving the posterior descending artery (PDA). Given the increased prevalence of myocardial bridging in the HCM population and its association with increased risk of myocardial ischemia, workup for angina-like symptoms should incorporate evaluation for a myocardial bridge.