CORONARY MYOCARDIAL BRIDGE, A LONG TERM FOLLOW UP STUDY

Abstract

Myocardial bridging is a congenital anomaly in which a segment of a coronary artery takes a “tunneled” intramuscular course under a “bridge” of overlying myocardium. This causes vessel compression in systole, resulting in hemodynamic changes that may be associated with angina, myocardial ischemia, acute coronary syndrome, left ventricular dysfunction, arrhythmias, and even sudden cardiac death. India is being laden with increasing incidences of coronary heart disease out from clinical presentation through a simplified investigation profile their morbidity may be addressed in a distinguished manner which has a less malignant course of progression. The present study is designed with an objective to identify the clinical spectrum of presentation of coronary myocardial bridge and to evaluate such cases with simple conventional noninvasive and invasive tests. All cases of angina attending the medical and cardiology OPD for the first time at the central hospital, S.E.C. Railway, Bilaspur (CG) between April 2011 to March 2016. After basic investigations all angina cases were evaluated by resting ECG and Echocardiography. Cases with normal resting Echo study were subjected to Tread Mill Test (TMT) with Bruce protocol. Total 1362 (female =354) cases of angina attended for first time in OPD. Out of which 271 (72%) cases had atherosclerotic coronary artery disease (CAD), 61(16%) cases were having CMB and 43 (12%) cases had normal coronaries. 54 patients out of 61 of CMB remained free of symptoms where as 29 out of 43 cases of CAD on medical management. First-line therapy involves medical treatment with betablockers and non-dihydropyridine calcium-channel blockers. From the present study, the researchers observed better results with betablockers added with nikorandil. A prospective randomized trial is required to identify the best treatment strategy for patients with myocardial bridging.