Myocardial bridging, a trigger for Takotsubo syndrome

Excerpt

A 71-year-old female presented with angina and ST elevation in leads V2–V4 on the electrocardiogram. Coronary angiography excluded stenotic lesions. A wrap-around left anterior descending (LAD) with myocardial bridging in the mid-segment was observed (Fig. 1a, d, arrowheads, Video 1). Intravascular ultrasound demonstrated systolic compression of the mid-LAD with a minimum lumen area of 3.06 mm² (systole) to 5.02 mm² (diastole) and an echolucent region between the bridged segment and epicardial tissue persisting throughout the cardiac cycle (‘half-moon sign’) (b, e, arrows, Video 2) [1]. Left ventriculography revealed mid-apical ballooning (c, f, arrowheads, Video 3), corresponding with the diagnosis of Takotsubo syndrome. High-sensitive troponin-T (normal ≤30 ng/l) was elevated, reaching a peak (590 ng/l) after 12 h. The patient recalled no trigger. At follow-up she was asymptomatic with normal echocardiography (Video 4).

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