Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Filter by Categories
Acknowledgements
Authors’ reply
Book Review
Book Reviews
Classics In Indian Medicine
Clinical Case Report
Clinical Case Reports
Clinical Research Methods
Clinico-pathological Conference
Clinicopathological Conference
Conferences
Correspondence
Corrigendum
Editorial
Eminent Indians in Medicine
Errata
Erratum
Everyday Practice
Film Review
History of Medicine
HOW TO DO IT
Images In Medicine
Indian Medical Institutions
Letter from Bristol
Letter from Chennai
Letter From Ganiyari
Letter from Glasgow
Letter from London
Letter from Mangalore
Letter From Mumbai
Letter From Nepal
Masala
Medical Education
Medical Ethics
Medicine and Society
News From Here And There
Notice of Retraction
Notices
Obituaries
Obituary
Original Article
Original Articles
Review Article
Selected Summaries
Selected Summary
Short Report
Short Reports
Speaking for Myself
Speaking for Ourselve
Speaking for Ourselves
Students@nmji
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Filter by Categories
Acknowledgements
Authors’ reply
Book Review
Book Reviews
Classics In Indian Medicine
Clinical Case Report
Clinical Case Reports
Clinical Research Methods
Clinico-pathological Conference
Clinicopathological Conference
Conferences
Correspondence
Corrigendum
Editorial
Eminent Indians in Medicine
Errata
Erratum
Everyday Practice
Film Review
History of Medicine
HOW TO DO IT
Images In Medicine
Indian Medical Institutions
Letter from Bristol
Letter from Chennai
Letter From Ganiyari
Letter from Glasgow
Letter from London
Letter from Mangalore
Letter From Mumbai
Letter From Nepal
Masala
Medical Education
Medical Ethics
Medicine and Society
News From Here And There
Notice of Retraction
Notices
Obituaries
Obituary
Original Article
Original Articles
Review Article
Selected Summaries
Selected Summary
Short Report
Short Reports
Speaking for Myself
Speaking for Ourselve
Speaking for Ourselves
Students@nmji
View/Download PDF

Translate this page into:

Images in Medicine
36 (
5
); 339-339
doi:
10.25259/NMJI_1112_2022

Myocardial bridging: A rare case of tunnelled coronary

Department of Pathology, Karwar Institute of Medical Sciences, MG Road, Karwar, Karnataka, India
Department of Forensic Medicine, Karwar Institute of Medical Sciences, MG Road, Karwar, Karnataka, India
Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

[To cite: Mahalingashetti PB, Pramod Kumar GN. Myocardial bridging: A rare case of tunnelled coronary. Natl Med J India 2023;36:339. DOI: 10.25259/NMJI_1112_2022]

The deceased man, aged 38 years, had briefly complained of breathlessness before succumbing at home in the morning hours. Pathological examination of the lungs revealed pulmonary congestion predominantly in the lower lobes. None of the non-cardiac causes of pulmonary congestion seemed plausible on evaluation. Examination of the heart showed a short segment of the left anterior descending artery running its course through the superficial myocardium. Microscopy showed ‘tunnelling’ of the coronary artery surrounded by a coat of myocardium, termed ‘Myocardial bridging’ (Fig. 1). Higher magnification also revealed an eccentric, focal atheroma within the media of the tunnelled segment (Fig. 2). Microscopy of the myocardial wall supplied by the bridged artery showed no evidence of infarction. Myocardial bridging is uncommon, and seen in 5% of routine angiograms.1 The myocardial coat/bridge can measure 1–10 mm. There are lately rare reports of deaths attributed to bridging. Previous reports have listed angina, low left ventricle function, arrhythmia and myocardial stunning as possible clinical associations. Myocardial bridging typically results in coronary filling defects during systole.2 Hence, it can be deduced that during strenuous physical exercise, shortened diastole, increased demand and coronary under-filling can collectively result in myocardial under-perfusion. Blood flow through a narrow vessel can cause shear stress which propagates atherosclerosis. The presence of atheroma in this report also highlights that myocardial bridging can promote atherosclerosis.

Myocardium of 2 mm thickness (blue arrow) surrounding the left anterior descending artery (H&E stain, 200x)
FIG 1.
Myocardium of 2 mm thickness (blue arrow) surrounding the left anterior descending artery (H&E stain, 200x)
Lipid core (blue arrow) of eccentric focal atheroma in tunnelled segment of the left anterior descending artery (H&E stain, 400x)
FIG 2.
Lipid core (blue arrow) of eccentric focal atheroma in tunnelled segment of the left anterior descending artery (H&E stain, 400x)

ACKNOWLEDGEMENTS

The Dean and Director, and Professor and Head of Forensic Medicine for permission to publish this case image.

References

  1. , , , . Update on myocardial bridging. Circulation 2002:2616-22.
    [CrossRef] [PubMed] [Google Scholar]
  2. , , , . Myocardial bridging: A forgotten cause of acute coronary syndrome––a case report. Int J Angiol 2007:115-18.
    [CrossRef] [PubMed] [Google Scholar]

Fulltext Views
228

PDF downloads
33
View/Download PDF
Download Citations
BibTeX
RIS
Show Sections