Anesthetic considerations in patients with the presence of intramyocardial bridges. The milking Syndrome.

Abstract

As intramyocardial bridges are known those segments of the coronary arteries that enter the thickness of the myocardial muscle, instead of passing through the epicardium throughout their way. This fact conditions the compression and dilation of these segments during the cardiac cycle, which, angiographically, is considered a milking phenomenon. Patients are usually asymptomatic and have a good long-term prognosis, although they may present with ischemic events, cardiac arrhythmias and even sudden death, precipitated mainly by episodes of tachycardia or stress. It is usually an incidental finding when performing a coronary angiography, or a multidetector CT, which is the test of choice. Treatment is based on heart rate control by beta-blockers or calcium antagonists, although therapies such as angioplasty or surgery may become necessary.

We present the management of a patient with this condition and discuss some interesting aspects from the anesthetic point of view.