Tako-tsubo-like cardiomyopathy induced by pheochromocytoma crisis.

shown in LAD (Video 1). Troponin I levels increased significantly and the transthoracic echocardiography showed wall motion abnormalities in anterior, apical and septal segments of left ventricle. Myocardial bridges consist of muscle fiber bundles lining an epicardial coronary artery for a variable distance. They are found in 10% of all coronary angiography procedures. The vessel wall underneath the muscular bridge is usually thin and free from degenerative atherosclerotic changes. A coronary stenosis caused by a short muscular bridge is considered critical when greater than 75%. Bridging of the epicardial coronary arteries has been described only in association with the left ventricular myocardium and most commonly with the LAD. Especially myocardial bridges in both LAD and diagonal branches are very rare. In our case, the patient has myocardial bridges in both LAD and its diagonal branch. Although myocardial bridges are usually associated with a benign prognosis, being in many cases asymptomatic and only found by chance, their presence has also been considered a cause of angina, malignant arrhythmia, myocardial infarction and sudden death. Therefore when patients has not any atherosclerotic risk factors and applied with acute coronary syndromes, percutaneous intervention may be prefer as reperfusion strategy as we did. We evaluated that the reasons of the myocardial infarction were the insufficient blood flow through the bridging arteries and the micro-thromboembolism from narrowing vessel segments. Other mechanisms such as neurohumoral or metabolic, may be played role in this case. Further studies need in this subject.