JACC. Case reports · 2026
Complex MINOCA With Myocardial Bridge, Vasospasm, and Microvascular Dysfunction in an HCM Patient.
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Wong Alan, Muuse Janelle, Iyengar Amrita, Bhatia Ankit, Quesada Odayme, Henry Timothy D
Аннотация
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 Pd/Pa" 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 Pd/Pa pressure waveform distal to a severe myocardial bridge.
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 Pd/Pa" 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 Pd/Pa pressure waveform distal to a severe myocardial bridge.