Presentation
Dyspnea on exertion. Past medical history of diabetes mellitus and hypertension.
Patient Data
Age: 65 years
Gender: Male
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- Myocardial bridging associated with the mid left anterior descending artery distal to the second diagonal branch
- There is mild to moderate reduction in vessel caliber on imaging reconstructed at 75 percent of the RR interval (during ventricular diastole) - key image 1
- This segment demonstrates severe vessel narrowing on imaging reconstructed at 34 percent of the RR interval (during ventricular systole) - key image 2
- The remaining left anterior descending artery remains patent and can be traced distally to the cardiac apex
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- There is mild to moderate reduction in vessel caliber on imaging reconstructed at 75 percent of the RR interval (during ventricular diastole) - key image 1
- This segment demonstrates severe vessel narrowing on imaging reconstructed at 34 percent of the RR interval (during ventricular systole) - key image 2
Case Discussion
The caliber change during ventricular systole indicates dynamic extrinsic compression of the left anterior descending coronary artery at this level. This phenomenon is known as milking.