ArticleFrontiers in cardiovascular medicine2025
Uncommon association of coronary artery ectasia and myocardial bridge presenting as non-ST-segment elevation myocardial infarction: a case report.
Article in Frontiers in cardiovascular medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Coronary artery ectasia (CAE)-diffuse dilatation ≥1.5× the adjacent segments is uncommon and lacks standardized management. Its coexistence with a hemodynamically significant myocardial bridge (MB) is unusual and may create competing disturbances in coronary flow that complicate diagnosis and treatment. Case presentation: An 80-year-old man with hypothyroidism, epilepsy, benign prostatic hyperplasia, and paroxysmal atrial fibrillation on rivaroxaban presented with acute precordial pain consistent with non-ST-segment elevation myocardial infarction (NSTEMI). He was hemodynamically stable; ECG showed inferior ST depression with T-wave inversion in V3-V4, and high-sensitivity troponin was elevated (Killip I, GRACE 177, CRUSADE 49). Early diagnostic angiography (<24 h) revealed diffuse three-vessel ectasia (Markis I) with slow TIMI-2 flow and a prominent mid-LAD MB (∼75% systolic "milking"); the intermediate branch had an ostial lesion with downstream aneurysmal dilatation and was not amenable to PCI. Echocardiography showed LVEF >65% with basal inferior/inferoseptal hypokinesia and severe left-atrial enlargement (57 ml/m Conclusions: Diffuse CAE with significant MB can precipitate NSTEMI without discrete obstructive lesions and challenges standard revascularization. In such anatomy, individualized conservative therapy-rate control and tailored antithrombotic management-may be preferable, while advanced imaging and diastolic physiology can refine diagnosis and selection for invasive strategies.
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