Li Bai has a poetic cloud: "The river city is picturesque, and the mountains look at the clear sky at night." Two water clip mirrors, double bridges fall rainbow". There are thousands of such romantic bridges, so can the "bridge" fall on our hearts? Is it also romantic? Let's take a look at the story of Uncle Mo, who was treated for chest tightness.
Uncle Mo, 56, reported that his heart was aggravated after manual labor, and he came to the Second People's Hospital of Hunan Province for treatment. In the process of examining the patient's cause, Dr. Xiong of the Cardiovascular Rehabilitation Department found that the patient had a horizontal abnormal downward movement of the ST segment of the anterior lateral wall lead and a low T wave and a negative positive and positive direction through a 12-lead synchronous ECG.
After comprehensive consideration, the doctor suggested that Uncle Mo check a coronary blood vessel CTA, the results were expected but also unexpected, the examination showed that the heart vessels did not see stenosis and plaque, but there was a superficial anterior descending branch myocardial bridge!
What is a myocardial bridge? Xing Zuzhong, director of the Department of Cardiovascular Rehabilitation, explained that under normal circumstances, the coronary arteries and their branches are walking on the surface of the subcardiac myocardium and adipose tissue, and if some or several parts of the myocardial fibers are walked in the myocardial fibers and are covered by myocardial fibers that resemble bridges, the myocardial fiber bundle is called the myocardial bridge, and the coronary artery segment covered by the myocardium is called the parietal coronary artery. Most patients have ST-segment horizontal or downward oblique depression on ecglyograms, T-wave biphasic, or inverted. A small number of patients have a normal ECG, and in severe cases, they present with ST-segment elevation or abnormal Q waves. The cause of the abnormality is when the parietal coronary arteries are squeezed during the contraction period of each cardiac cycle, even until the early and middle stages of diastolic, resulting in decreased blood flow or interruption to induce myocardial ischemia.
The arrow refers to the location of the myocardial bridge shown by the patient's coronary CT
Is the "bridge" that falls on the heart romantic? Xing Zuzhong, director of the Department of Cardiovascular Rehabilitation, further introduced that the myocardial bridge will cause some symptoms, including chest tightness and discomfort, especially when patients are more obvious in strenuous activities such as running and climbing, because the blood flow reserves of the coronary arteries of the heart are reduced after the heart rate is accelerated, and even the patients will have chest pain symptoms. Myocardial bridges have been thought to be benign anatomical variants in the past, but with the development of imaging techniques, more and more studies have shown that myocardial bridges can lead to serious cardiovascular events, including sudden cardiac death.
Although patients with asymptomatic myocardial bridges do not require treatment, drug therapy should be preferred for those with significant symptoms such as this patient to reduce heart rate and myocardial oxygen consumption, and if atherosclerotic changes in the proximal coronary arteries of the parietal atherosclerosis are found, anti-atherosclerotic drugs should be given to reduce the occurrence of cardiovascular events.
In particular, in patients at low risk of coronary heart disease, myocardial bridges should be considered if abnormal changes in ECG ST-T are accompanied by symptoms similar to angina or myocardial ischemia.
This kind of "bridge" is not romantic, and such patients are also sloppy!
Author: ECG Room Li Qiong
Editor: Shi Rong
Image: Partly from the Internet, invaded and deleted