Background: Myocardial bridging is a common anatomical malformation, and the milking effect is a characteristic phenomenon of myocardial bridging in coronary angiography. Generally, the phenomenon is invariable. However, this article reports an inconceivably rare myocardial bridging phenomenon that breaks through our conventional views. The milking effect changed obviously in two coronary angiography examinations, which subverted the traditional deep-rooted view of the myocardial bridging phenomenon and revealed the limitations of coronary angiography in diagnosing myocardial bridging and judging the prognosis of it.
Case summary: A 63-year-old man was diagnosed with ST-segment elevation myocardial infarction and received primary percutaneous coronary intervention on December 26, 2019. His heart rate was 104 beats per minute, and blood pressure was 15.3/10.3 kPa. A severe milking effect was found in the left anterior descending coronary artery during his index coronary angiography on January 14, 2020. The patient was given intensive medical management, including a β1-adrenergic receptor blocker, during hospitalization and after discharge. Unexpectedly, coronary angiography showed that the previous impressive milking effect was dramatically alleviated (close to normal) at the follow-up on October 13, 2020. At that moment, the patient's heart rate was 83 beats per minute, and blood pressure was 12.7/8.0 kPa.
Conclusion: The myocardial bridging phenomenon is not invariable and, in certain circumstances, may vary. Furthermore, the autonomic nervous system may be involved in the myocardial bridging phenomenon.
Keywords: Autonomic nervous system; Case report; Coronary angiography; Endocrine system; Milking effect; Myocardial bridging.
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