Bridging the Gap in a Rare Cause of Angina

Myocardial bridging occurs when coronary arteries run intramurally. Episodes of tachycardia can cause a dynamic obstruction that extends into diastole, compromising coronary filling time, and subsequently leading to ischaemia. Myocardial ischaemia, acute coronary syndrome, coronary spasm, myocardial...

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Autores principales:	Sumanth Khadke, Jovana Vidovic, Vinod Patel
Formato:	article
Lenguaje:	EN
Publicado:	Radcliffe Medical Media 2021
Materias:	Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/6526b2497a3e4a248f3f3802880a8a30
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spelling	oai:doaj.org-article:6526b2497a3e4a248f3f3802880a8a302021-12-04T16:04:01ZBridging the Gap in a Rare Cause of Angina10.15420/ecr.2020.331758-37641758-3756https://doaj.org/article/6526b2497a3e4a248f3f3802880a8a302021-03-01T00:00:00Zhttps://www.ecrjournal.com/articleindex/ecr.2020.33https://doaj.org/toc/1758-3756https://doaj.org/toc/1758-3764Myocardial bridging occurs when coronary arteries run intramurally. Episodes of tachycardia can cause a dynamic obstruction that extends into diastole, compromising coronary filling time, and subsequently leading to ischaemia. Myocardial ischaemia, acute coronary syndrome, coronary spasm, myocardial stunning, arrhythmia, takotsubo cardiomyopathy, and sudden cardiac death have all been reported with bridging. Atherosclerotic plaques develop proximally in the bridge due to low shear stress and high oscillatory wall-flow. Factors affecting atherosclerotic build-up include disrupted flow patterns (particularly flow recirculation, which exacerbates LDL internalisation), cell adhesion and monocyte adhesion to the endothelium. Endothelial health depends on arterial flow patterns, given that the vessel reacts differently to various flow types, as confirmed in 3D simulations. Medication is the first-line therapy, while surgical de-roofing and coronary bypass are reserved for severe stenosis. Distinguishing physiological arterial compression from pathological stenosis is essential. Deeper bridges correlating with recurrent angina with an instantaneous wave-free ratio ≤0.89 or fractional flow reserve ≤0.80 are treated.Sumanth KhadkeJovana VidovicVinod PatelRadcliffe Medical MediaarticleDiseases of the circulatory (Cardiovascular) systemRC666-701ENEuropean Cardiology Review , Vol 16, Iss , Pp - (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	Diseases of the circulatory (Cardiovascular) system RC666-701 Sumanth Khadke Jovana Vidovic Vinod Patel Bridging the Gap in a Rare Cause of Angina
description	Myocardial bridging occurs when coronary arteries run intramurally. Episodes of tachycardia can cause a dynamic obstruction that extends into diastole, compromising coronary filling time, and subsequently leading to ischaemia. Myocardial ischaemia, acute coronary syndrome, coronary spasm, myocardial stunning, arrhythmia, takotsubo cardiomyopathy, and sudden cardiac death have all been reported with bridging. Atherosclerotic plaques develop proximally in the bridge due to low shear stress and high oscillatory wall-flow. Factors affecting atherosclerotic build-up include disrupted flow patterns (particularly flow recirculation, which exacerbates LDL internalisation), cell adhesion and monocyte adhesion to the endothelium. Endothelial health depends on arterial flow patterns, given that the vessel reacts differently to various flow types, as confirmed in 3D simulations. Medication is the first-line therapy, while surgical de-roofing and coronary bypass are reserved for severe stenosis. Distinguishing physiological arterial compression from pathological stenosis is essential. Deeper bridges correlating with recurrent angina with an instantaneous wave-free ratio ≤0.89 or fractional flow reserve ≤0.80 are treated.
format	article
author	Sumanth Khadke Jovana Vidovic Vinod Patel
author_facet	Sumanth Khadke Jovana Vidovic Vinod Patel
author_sort	Sumanth Khadke
title	Bridging the Gap in a Rare Cause of Angina
title_short	Bridging the Gap in a Rare Cause of Angina
title_full	Bridging the Gap in a Rare Cause of Angina
title_fullStr	Bridging the Gap in a Rare Cause of Angina
title_full_unstemmed	Bridging the Gap in a Rare Cause of Angina
title_sort	bridging the gap in a rare cause of angina
publisher	Radcliffe Medical Media
publishDate	2021
url	https://doaj.org/article/6526b2497a3e4a248f3f3802880a8a30
work_keys_str_mv	AT sumanthkhadke bridgingthegapinararecauseofangina AT jovanavidovic bridgingthegapinararecauseofangina AT vinodpatel bridgingthegapinararecauseofangina
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Bridging the Gap in a Rare Cause of Angina

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