An unusual case of acute coronary syndrome associated with myocardial bridging in a patient with hypertrophic cardiomyopathy and apical aneurysm: a case report

Abstract Hypertrophic cardiomyopathy is a common inherited cardiac disease characterized by unexplained left ventricular hypertrophy in the absence of abnormal loading conditions. Myocardial bridging occurs when a segment of an epicardial coronary artery follows an intramyocardial course beneath an overlying muscular bridge. This anatomical variant is frequently observed in patients with hypertrophic cardiomyopathy, and its clinical manifestations may closely resemble those of the underlying cardiomyopathy. The frequent coexistence of these two entities makes it challenging to determine the precise contribution of myocardial bridging to myocardial ischemia. Case summary We present the case of a patient with obstructive mid-ventricular hypertrophic cardiomyopathy and an apical aneurysm who presented with a non-ST-segment elevation myocardial infarction. Coronary angiography revealed no significant obstructive coronary artery disease but demonstrated myocardial bridging of the mid-left anterior descending artery. Conclusion The coexistence of obstructive mid-ventricular hypertrophic cardiomyopathy, an apical aneurysm, and myocardial bridging of the left anterior descending artery is exceptionally rare and highlights the complex interplay among dynamic systolic obstruction, microvascular ischemia, and apical remodeling, with important implications for diagnostic evaluation and individualized management.