Presentation
Chest pain, for CTCA.
Patient Data
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Coronary Angiography
Origins: Normal Dominance: Left
Left Main Coronary Artery (LMCA): Normal.
Left Anterior Descending (LAD): Large amount of complete myocardial bridging of the mid segment. No obstructive disease evident. No diagonal branch identified.
Circumflex artery (Cx): Normal.
1st obtuse marginal branch (OM1), OM2, OM3: Normal, and distal vessels not well visualized.
Right Coronary Artery (RCA): Small vessel, Normal.
Posterior descending artery (PDA) and Posterior left ventricular branch (PLV): not well-visualized.
Cardiovascular Findings:
Dual lead pacemaker wires noted, causing moderately severe artifact. Enlarged left atrium. Minor aortic valvular calcification.
Case Discussion
The LAD dives quite deep into the myocardium. Myocardial bridging is often asymptomatic, however in this case it was presumed to be the cause of the symptoms due to both the absence of any CAD and the severity of bridging.