CONGRESS ABSTRACT

The Myocardial Bridge as a Cause of Acute Coronary Syndrome A 60-year-old female patient. In her medical history, she has no allergies and reports premenopausal syndrome and diverticulosis of the colon as associated conditions. From a recent cardiovascular history perspective, the patient reported the onset of constrictive chest pain at rest in the retrosternal area that radiated to the jugular, associated with profuse sweating and paresthesia in all four limbs, resolving after about an hour. The following day, after performing physical exercise, the pain reappeared, prompting her to go to the emergency department. Elevated troponin levels were found (927 → 4039 ng/L) in the absence of ECG and echographic alterations. Considering the diagnosis of acute myocardial infarction without ST-segment elevation (NSTEMI), a coronary angiography was performed, confirming the absence of hemodynamically significant lesions but highlighting the presence of a myocardial bridge in the middle anterior interventricular branch. As noted in the literature, various methods exist for the structural and functional analysis of bridges; therefore, a coronary CT scan was performed, confirming the diagnosis of a bridge at the limits of complexity (< 25 mm in length, > 5 mm in depth). Doubting that the bridge was the cause of acute coronary syndrome (ACS), a functional evaluation with SPECT was conducted, which indicated reversible stress-induced ischemia in the territory of the bridge. Based on these findings, beta-blocker therapy was initiated to promote diastolic release from the myocardial bridge, and aspirin and statin were prescribed as protection against potential soft plaque proximal to the bridge. Conclusion To summarize, there is no standardized diagnostic and evaluation protocol for myocardial bridges despite being an occasional finding with significant epidemiological impact (up to 30% of the general population). This clinical case aims to demonstrate that myocardial bridges should be considered in the differential diagnosis of MINOCA (Myocardial Infarction with Non-Obstructive Coronary Arteries), emphasizing the need for a diagnostic and therapeutic pathway recognized by scientific societies.