Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with exertional angina, substernal chest pressure, and occasional palpitations. Symptoms are exacerbated by physical activity and emotional stress, relieved by rest. No history of syncope or documented arrhythmias. Coronary angiography/CTA demonstrates systolic compression of the [LAD/RCA/LCx] artery, consistent with myocardial bridging.
Clinical Examination Findings
Cardiovascular exam: Regular rate and rhythm, S1/S2 audible, no murmurs, rubs, or gallops. Peripheral pulses are 2+ and symmetric. No signs of congestive heart failure (no JVD, no peripheral edema). Resting ECG shows [normal sinus rhythm/ST-segment changes during exercise].
Treatment Protocol
Initiate beta-blocker therapy (e.g., Metoprolol or Atenolol) to reduce heart rate, increase diastolic filling time, and decrease myocardial contractility. Calcium channel blockers (e.g., Diltiazem or Verapamil) are indicated if beta-blockers are contraindicated or ineffective. Avoid nitrates as they may exacerbate systolic compression. Surgical myotomy or coronary stenting reserved for refractory cases.