Case Reports Journal Article Ahead of print
PubMed: 42216946 DOI: 10.1016/j.jaccas.2026.108613
Complex MINOCA With Myocardial Bridge, Vasospasm, and Microvascular Dysfunction in an HCM Patient.
JACC Case Rep
Authors: Alan Wong, Janelle Muuse, Amrita Iyengar, Ankit Bhatia, Odayme Quesada, Timothy D Henry
Affiliations
- Department of Cardiovascular Disease, The Christ Hospital, Cincinnati, Ohio, USA.
- Department of Cardiovascular Disease, The Christ Hospital, Cincinnati, Ohio, USA.
- Carl and Edyth Lindner Research Center, The Christ Hospital, Cincinnati, Ohio, USA.
Abstract
BACKGROUND
Myocardial infarction with nonobstructive coronary arteries (MINOCA) is frequent, and the etiology is heterogenous.
CASE SUMMARY
A 61-year-old man with hypertrophic cardiomyopathy presented with non-ST-segment elevation myocardial infarction. Coronary angiogram revealed a severe mid-distal left anterior descending myocardial bridge with nonobstructive coronary artery disease consistent with MINOCA. Coronary function testing revealed severe epicardial coronary vasospasm and severe endothelial-dependent and -independent microvascular dysfunction in addition to the physiologically significant myocardial bridge with a unique "reverse P d/P a" pressure waveform.
DISCUSSION
In a myocardial bridge, the compression of the coronary artery causes a systolic pressure overshoot and negative pressure gradient resulting in unreliable fractional flow reserve measurements. Physiological assessment with diastolic indices is more accurate for functional assessment of myocardial bridges.
TAKE-HOME MESSAGES
The etiology of MINOCA is heterogeneous, and coronary function testing is often crucial for workup. We present a unique reverse P d/P a pressure waveform distal to a severe myocardial bridge.
MeSH
Coronary Angiography, Research Design, Myocardial Infarction, Arteries