Bridging the Gap in a Rare Cause of Angina
Myocardial bridging occurs when coronary arteries run intramurally. Episodes of tachycardia can cause a dynamic obstruction that extends into diastole, compromising coronary filling time, and subsequently leading to ischaemia. Myocardial ischaemia, acute coronary syndrome, coronary spasm, myocardial...
Saved in:
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Radcliffe Medical Media
2021-03-01
|
| Series: | European Cardiology Review |
| Online Access: | https://www.ecrjournal.com/articleindex/ecr.2020.33 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1846122467114876928 |
|---|---|
| author | Sumanth Khadke Jovana Vidovic Vinod Patel |
| author_facet | Sumanth Khadke Jovana Vidovic Vinod Patel |
| author_sort | Sumanth Khadke |
| collection | DOAJ |
| description | Myocardial bridging occurs when coronary arteries run intramurally. Episodes of tachycardia can cause a dynamic obstruction that extends into diastole, compromising coronary filling time, and subsequently leading to ischaemia. Myocardial ischaemia, acute coronary syndrome, coronary spasm, myocardial stunning, arrhythmia, takotsubo cardiomyopathy, and sudden cardiac death have all been reported with bridging. Atherosclerotic plaques develop proximally in the bridge due to low shear stress and high oscillatory wall-flow. Factors affecting atherosclerotic build-up include disrupted flow patterns (particularly flow recirculation, which exacerbates LDL internalisation), cell adhesion and monocyte adhesion to the endothelium. Endothelial health depends on arterial flow patterns, given that the vessel reacts differently to various flow types, as confirmed in 3D simulations. Medication is the first-line therapy, while surgical de-roofing and coronary bypass are reserved for severe stenosis. Distinguishing physiological arterial compression from pathological stenosis is essential. Deeper bridges correlating with recurrent angina with an instantaneous wave-free ratio ≤0.89 or fractional flow reserve ≤0.80 are treated. |
| format | Article |
| id | doaj-art-6526b2497a3e4a248f3f3802880a8a30 |
| institution | Kabale University |
| issn | 1758-3756 1758-3764 |
| language | English |
| publishDate | 2021-03-01 |
| publisher | Radcliffe Medical Media |
| record_format | Article |
| series | European Cardiology Review |
| spelling | doaj-art-6526b2497a3e4a248f3f3802880a8a302024-12-14T16:02:34ZengRadcliffe Medical MediaEuropean Cardiology Review1758-37561758-37642021-03-011610.15420/ecr.2020.33Bridging the Gap in a Rare Cause of AnginaSumanth Khadke0Jovana Vidovic1Vinod Patel2Our Lady of Fatima University, Fatima College of Medicine, Manila, PhilippinesSemmelweis University, Budapest, HungaryDivision of Cardiology, Mount Sinai Hospitals, New York, NY, USMyocardial bridging occurs when coronary arteries run intramurally. Episodes of tachycardia can cause a dynamic obstruction that extends into diastole, compromising coronary filling time, and subsequently leading to ischaemia. Myocardial ischaemia, acute coronary syndrome, coronary spasm, myocardial stunning, arrhythmia, takotsubo cardiomyopathy, and sudden cardiac death have all been reported with bridging. Atherosclerotic plaques develop proximally in the bridge due to low shear stress and high oscillatory wall-flow. Factors affecting atherosclerotic build-up include disrupted flow patterns (particularly flow recirculation, which exacerbates LDL internalisation), cell adhesion and monocyte adhesion to the endothelium. Endothelial health depends on arterial flow patterns, given that the vessel reacts differently to various flow types, as confirmed in 3D simulations. Medication is the first-line therapy, while surgical de-roofing and coronary bypass are reserved for severe stenosis. Distinguishing physiological arterial compression from pathological stenosis is essential. Deeper bridges correlating with recurrent angina with an instantaneous wave-free ratio ≤0.89 or fractional flow reserve ≤0.80 are treated.https://www.ecrjournal.com/articleindex/ecr.2020.33 |
| spellingShingle | Sumanth Khadke Jovana Vidovic Vinod Patel Bridging the Gap in a Rare Cause of Angina European Cardiology Review |
| title | Bridging the Gap in a Rare Cause of Angina |
| title_full | Bridging the Gap in a Rare Cause of Angina |
| title_fullStr | Bridging the Gap in a Rare Cause of Angina |
| title_full_unstemmed | Bridging the Gap in a Rare Cause of Angina |
| title_short | Bridging the Gap in a Rare Cause of Angina |
| title_sort | bridging the gap in a rare cause of angina |
| url | https://www.ecrjournal.com/articleindex/ecr.2020.33 |
| work_keys_str_mv | AT sumanthkhadke bridgingthegapinararecauseofangina AT jovanavidovic bridgingthegapinararecauseofangina AT vinodpatel bridgingthegapinararecauseofangina |