When the Heart Cries Wolf: Myocardial Bridging Presenting as Angina-like Chest Pain

Myocardial bridging (MB) is the most common congenital coronary anomaly and refers to an intramural course of an epicardial coronary artery. The proximal segment of the left anterior descending artery (LAD) is the most commonly involved vessel and is often seen in patients with hypertrophic cardiomyopathy (HCM). We present a case of a 64-year-old female with left-sided non-exertional chest pain. Electrocardiography (EKG) and echocardiography were negative, however, stress EKG was positive with deep ST-segment depressions. Coronary angiography revealed mid-segment compression of LAD during systole, returning to its normal caliber during diastole. The patient remained asymptomatic during the hospital course and was later discharged on beta-blocker therapy. This case is different from others in a sense that it presented with severe pain like angina and mid-segment of LAD is involved rather than the proximal segment where it commonly occurs. This case report will help clinicians overcome the diagnostic challenge in patients presenting with atypical chest pain.