Myocardial Bridge Causing Ventricular Tachycardia in a Competitive Athlete.

BACKGROUND

Arrhythmias associated with syncope and chest discomfort in competitive athletes include a wide differential. Evaluation of coronary artery anatomy is an essential component of work-up for a potential etiology.

CASE SUMMARY: A competitive high school swimmer presented to sports cardiology clinic with multiple episodes of exertional chest discomfort, syncope, and wide complex tachycardia. Work-up revealed a left anterior descending myocardial bridge of 5 mm depth and 2.5 cm length. After evaluation, he underwent surgical division of the myocardial bridge and returned to sport without symptoms or recurrent episodes of ventricular tachycardia.

DISCUSSION: Myocardial bridging is a common finding that is typically benign; however, it may be underrecognized as a cause for chest discomfort, wide complex tachycardia, syncope, and sudden death in athletes. In the appropriate setting, surgical division of the bridge can be a definitive management strategy for athletes with clinically significant myocardial bridging.

TAKE-HOME MESSAGES: Coronary artery anomalies are a known cause of sudden cardiac arrest in athletes. The coronary arteries should be thoroughly evaluated in any athlete with symptoms concerning for a cardiac etiology. Although commonly benign, a clinically significant myocardial bridge may be an etiology for chest discomfort and syncope in competitive athletes. Surgical division of the bridge is a potential management strategy.