Differential local spasticity in myocardial bridges.
To illustrate the effect of myocardial bridges on coronary vascular tone, we describe the cases of 2 patients with different clinical presentations in the context of reproducible increased spasticity at the site of myocardial bridging. One had an episode of takotsubo cardiomyopathy, and one developed typical Prinzmetal angina while receiving desmopressin treatment for pituitary insufficiency. In both patients, acetylcholine challenge clearly revealed both the presence and the severity of myocardial bridging while producing several recognizable degrees of abnormal spastic tendency.Both baseline functional states and responses to different medications correlate with spastic tendency and enable the characterization of individual cases. Understanding the spectrum of spastic conditions might help to clarify the causes of atypical ischemic events, especially in patients with myocardial bridging.
Division of Cardiology, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas 77030, USA. PAngelini@leachmancardiology.com
Paolo
P
Angelini
Carlo
C
Uribe
Pablo
P
Lozano
D000109:Acetylcholine; D000788:Angina Pectoris, Variant / Q000139:chemically induced / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D050034:Antidiuretic Agents / Q000009:adverse effects; D017023:Coronary Angiography; D003329:Coronary Vasospasm / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D003331:Coronary Vessels / Q000187:drug effects / Q000503:physiopathology*; D003894:Deamino Arginine Vasopressin / Q000009:adverse effects; D004452:Echocardiography; D005260:Female; D006801:Humans; D007018:Hypopituitarism / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D054084:Myocardial Bridging / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D011237:Predictive Value of Tests; D054549:Takotsubo Cardiomyopathy / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use
D050034:Antidiuretic Agents; D014665:Vasodilator Agents; D003894:Deamino Arginine Vasopressin; D000109:Acetylcholine