Encasement of the left anterior descending coronary artery: association with Takotsubo syndrome, and diagnostic and therapeutic options

Myocardial bridging is a rare event, which leads to chest pain, arrhythmias and discussable Takotsubo syndrome (cardiomyopathy). We enrolled 41 patients (33 females, mean age 68.4 years), the majority of whom had Takotsubo cardiomyopathy in any form, and 6 had echocardiographic midventricular hypokinesia along with chest pain. Thirty patients had apical ballooning, 3 had midventricular ballooning, and 1 had basal ballooning, according to left ventricular angiography. Intravascular ultrasonography and fractional flow reserve with either an adenosine or dobutamine injection are the best methods for accurately diagnosing myocardial bridging. Beyond atherosclerosis, myocardial bridging is a prominent cause of chest pain, although ischemia is difficult to verify.