Iqbal S Khan, Salim M, Sania Nishtar, Naseer Ahmed, Mattu M A.
Myocardial Bridging: A case report.
J Pak Inst Med Sci Jan ;15(1):881-3.

A 36 years presented after the sudden onset of palpitations experienced while pushing a fully loaded medicine transport trolley. There was no associated chest pain or shortness of breath and he remained fully conscious. He smoked heavily for the past five years; risk assessment for coronary artery disease other than that was unremarkable. At the time of initial examination in the ER, he appeared to be comfortable with a regular pulse of 140/minute and a BP of 90/60 mm Hg. Cardiovascular examination revealed normal heart sound and no added sounds, examination of other systems was unremarkable. 12 lead ECG showed a regular ventricular rate of 140/ minute, with QRS duration of 120 milliseconds and evidence of AV dissociation. The axis was leftward with biphasic R in V1 and R/S less than 1 in V6. He was labelled as having Ventricular Tachycardia. Since he was hemodynamically stable he was initially treated with I/ V lignocaine and subsequently with I/V Amiodarone, both of which failed to revert the Tachycardia. He was ultimately reverted electrically with a D/C counter shock of 100 joules. His ECG revealed a normal sinus rhythm with T wave inversions in I, AVL, V3-V6. He was subsequently treated in the coronary care unit with oral Aspirin, I/ V Nitrates, and oral Beta Blockers. Laboratory profile inclusive of Serum Potassium, Magnesium, and renal functions were normal. 2D echocardiogram revealed no structural abnormalities. Diagnostic Coronary angiography performed the next day revealed pinching of the mid Left Anterior Descending Artery between the first and second septal perforator during systole only and mild antero-apical hypokinesia. He was labelled as case of myocardial bridging and was discharged on the fourth day of the initial presentation on oral Aspirin and Beta Blockers; he continues to do well on that treatment three years after the initial diagnosis.

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