Methods (differential diagnosis, Investigations and treatment)
She was re-investigated with ECG (Fig 1) and Troponin, both was normal. The Echo, CXR and TFT were also normal. After cardiology consultation, the patient undergoes Coronary CT Angiography. The CCTA shows a short segment (8mm) intra-myocardial course of distal LAD confirming the diagnosis of myocardial bridging. (Fig 2A-C and Fig 3)
After the diagnosis of myocardial bridging was confirmed, the patient was counseled on treatment options and she was initiated on Metoprolol 25 mg per oral daily. Subsequently, metoprolol was escalated to 25mg per oral twice daily and amlodipine 10mg per oral daily was added as non-dihydropyridines calcium channel blockers are not available in our setup.