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CASE REPORT
Year : 2022  |  Volume : 6  |  Issue : 2  |  Page : 87-91

Adenosine-Induced Myocardial Ischemia in a Patient with Myocardial Bridge: A Case Report


1 Department of Cardiology, Guangdong Provincial Cardiovascular Institute; Department of Cardiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
2 Department of Cardiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
3 Department of Cardiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences; Department of Cardiology, School of Medicine, South China University of Technology, Guangzhou, China

Correspondence Address:
Dr. Qingshan Geng
Guangdong Provincial Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences,106, 2nd Zhongshan Road, Yuexiu District, Guangzhou 510080
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/hm.hm_33_21

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The adenosine stress test and exercise stress test have been widely used in the diagnosis of coronary heart disease, which has high sensitivity and specificity for diagnosis of coronary heart disease. The myocardial bridge is a congenital dysplasia of the coronary artery which may cause severe myocardial ischemia, acute myocardial infarction, arrhythmia, and sudden death. Although drug therapy for this disease is clear and widely used, indication for open-chest surgery is still vague. This case shows a patient with long-term chest pain undergoing the coronary computed tomographic angiography in our hospital 1 month ago, which showed the mild myocardial bridge in the left anterior descending (LAD) branch. Then, she did the mental stress-induced myocardial ischemia and cardiopulmonary exercise test which the results were negative. After the informed consent, the patient took the adenosine stress test and severe angina occurred during the test. Later, coronary angiography showed that the myocardial bridge caused 70% contraction of the middle segment of the LAD branch. In the case of long-term ineffective drug treatment, the patient underwent a open-chest surgery called coronary artery myotomy and her chest discomfort eventually recovered. To a degree, adenosine stress test may be more sensitive than exercise stress test in predicting the severity of coronary artery stenosis. Moreover, we may provide a unique direction of indication for surgeons to operate open-chest surgery on the myocardial bridge.


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