<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1028-4818</journal-id>
<journal-title><![CDATA[Multimed]]></journal-title>
<abbrev-journal-title><![CDATA[Multimed]]></abbrev-journal-title>
<issn>1028-4818</issn>
<publisher>
<publisher-name><![CDATA[Centro Provincial de Información de Ciencias Médicas]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1028-48182024000100007</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Fenómeno de Milking secundario a puente intramiocárdico en paciente con bloqueo trifascicular]]></article-title>
<article-title xml:lang="en"><![CDATA[Milking phenomenon secondary to intramyocardial bridging in a patient with a trifascicular block]]></article-title>
<article-title xml:lang="pt"><![CDATA[Fenómeno de ordenha secundário a ponte intramiocárdica num doente com bloqueio trifascicular]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Rodríguez Peña]]></surname>
<given-names><![CDATA[Marian Maité]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Pérez Domínguez]]></surname>
<given-names><![CDATA[Julio Alberto]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Leyva Castro]]></surname>
<given-names><![CDATA[Raúl]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Sánchez Guerra]]></surname>
<given-names><![CDATA[José Alberto]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Matos Pupo]]></surname>
<given-names><![CDATA[Addiel]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad de Ciencias Médicas de Granma Hospital General Provincial Carlos Manuel de Céspedes ]]></institution>
<addr-line><![CDATA[Bayamo Granma]]></addr-line>
<country>Cuba</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>00</month>
<year>2024</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>00</month>
<year>2024</year>
</pub-date>
<volume>28</volume>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.sld.cu/scielo.php?script=sci_arttext&amp;pid=S1028-48182024000100007&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.sld.cu/scielo.php?script=sci_abstract&amp;pid=S1028-48182024000100007&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.sld.cu/scielo.php?script=sci_pdf&amp;pid=S1028-48182024000100007&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[RESUMEN  Introducción:  los puentes intramiocárdicos son una modificación anatómica de la circulación coronaria que consisten en secciones anormales en el espesor del miocardio que al formar segmentos tunelizados e incorporarse al epicardio, provocan un ordeñamiento vascular llamado fenómeno de Milking durante la compresión sistólica extrínseca, el cual es responsable de las manifestaciones clínicas y las alteraciones electrocardiográficas. Se describe un caso clínico con el objetivo de comunicar a la comunidad científica las características clínicas, eléctricas y coronariográficas de una paciente con síndrome coronario agudo con bloqueo trifascicular y fenómeno de Milking por puente intramiocárdico.  Caso clínico:  mujer de56 años, con antecedentes de hipertensión arterial, obesidad e historia de ingresos frecuentes por episodios de angina inestables; fue admitida por angina inestable aguda más bloqueo trifascicular y se confirmó puente intramiocárdico en el segmento medio distal de la arteria descendente anterior izquierda. La optimización de la terapia antiisquémica se basó en Carvedilol, previa implantación de marcapaso permanente.  Discusión:  los puentes intramiocárdicos causan reducción dinámica de la luz del vaso epicárdico coronario y cuando resulta mayor del 50% condiciona el fenómeno de Milking, el cual es más frecuente en los segmentos medio y distal de la arteria descendente anterior izquierda, su evolución es favorable y responden a la terapéutica con ß bloqueadores de forma adecuada.  Conclusiones:  la correlación diagnóstica facilitó la aplicación de una conducta invasiva con estimulación transvenosa permanente que permitió iniciar tratamiento betabloqueante lo cual no hubiera sido posible por el trastorno de la conducción intraventricular.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[ABSTRACT  Introduction: Intramyocardial bridges are an anatomical modification of the coronary circulation consisting of abnormal sections in the thickness of the myocardium that, when forming tunnel segments and incorporating into the epicardium, cause vascular milking, the so-called milking phenomenon, during extrinsic systolic compression, which is responsible for the clinical manifestations and electrocardiographic alterations. A clinical case is described with the aim of providing the scientific community with the clinical, electrical and coronary angiographic characteristics of a patient with acute coronary syndrome with trifascicular block and milking phenomenon due to intramyocardial bridging.  Case Report:  A 56-year-old woman with a history of hypertension, obesity, and frequent admissions for episodes of unstable angina was admitted for acute unstable angina plus trifascicular block and intramyocardial bridging was confirmed in the distal middle segment of the left anterior descending artery. Optimization of anti-ischemic therapy was based on carvedilol after implantation of a permanent pacemaker.  Discussion:  Intramyocardial bridges cause a dynamic reduction of the coronary epicardial vessel lumen and when it is greater than 50% it causes a milking phenomenon, which is more frequent in the middle and distal segments of the left anterior descending artery, its evolution is favorable and responds adequately to ß-blocker therapy.  Conclusions:  The diagnostic correlation facilitated the application of an invasive approach with permanent transvenous stimulation, allowing the initiation of beta-blocker treatment, which would not have been possible due to the intraventricular conduction disorder.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[RESUMO  Introdução:  As pontes intramiocárdicas são uma modificação anatómica da circulação coronária constituída por secções anómalas na espessura do miocárdio que, ao formarem segmentos em túnel e ao incorporarem-se no epicárdio, provocam a ordenha vascular, o chamado fenómeno de ordenha, durante a compressão sistólica extrínseca, responsável pelas manifestações clínicas e alterações electrocardiográficas. Descreve-se um caso clínico como objetivo de dar a conhecer à comunidade científica as características clínicas, eléctricas e coronariográficas de um doente com síndrome coronário agudo com bloqueio trifascicular e fenómeno de milking por bridging intramiocárdico.  Relato de Caso:  Mulher de 56 anos, com antecedentes de hipertensão arterial, obesidade e internamentos frequentes por episódios de angina instável, foi internada por angina aguda instável com bloqueio trifascicular e confirmação de ponte intramiocárdica no segmento médio distal da artéria descendente anterior. A otimização da terapêutica anti-isquémica foi baseada no carvedilol após implantação de pacemaker definitivo.  Discussão:  As pontes intramiocárdicas provocam uma redução dinâmica do lúmen do vaso epicárdico coronário e quando esta é superior a 50% provoca um fenómeno de ordenha, mais frequente nos segmentos médio e distal da artéria descendente anterior, a sua evolução é favorável e responde adequadamente à terapêutica com ß-bloqueantes.  Conclusões:  A correlação diagnóstica facilitou a aplicação de uma abordagem invasiva com estimulação transvenosa permanente, permitindo o início do tratamento com beta-bloqueadores, o que não teria sido possível devido ao distúrbio de condução intraventricular.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Puente intramiocárdico]]></kwd>
<kwd lng="es"><![CDATA[Fenómeno de Milking]]></kwd>
<kwd lng="es"><![CDATA[Coronariografía]]></kwd>
<kwd lng="es"><![CDATA[Síndrome coronario agudo]]></kwd>
<kwd lng="es"><![CDATA[Enfermedad coronaria]]></kwd>
<kwd lng="en"><![CDATA[Intramyocardial bridge]]></kwd>
<kwd lng="en"><![CDATA[Milking phenomenon]]></kwd>
<kwd lng="en"><![CDATA[Angiography]]></kwd>
<kwd lng="en"><![CDATA[Acute coronary syndrome]]></kwd>
<kwd lng="en"><![CDATA[Coronary artery disease]]></kwd>
<kwd lng="pt"><![CDATA[Ponte intramiocárdica]]></kwd>
<kwd lng="pt"><![CDATA[Fenômeno da ordenha]]></kwd>
<kwd lng="pt"><![CDATA[Angiografia]]></kwd>
<kwd lng="pt"><![CDATA[Síndrome coronária aguda]]></kwd>
<kwd lng="pt"><![CDATA[Doença coronariana]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Contreras-Alcázar]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Díaz-Taipe]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Rodríguez-Laura]]></surname>
<given-names><![CDATA[Z]]></given-names>
</name>
<name>
<surname><![CDATA[García-Salazar]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Nieto-Alejo]]></surname>
<given-names><![CDATA[Y]]></given-names>
</name>
<name>
<surname><![CDATA[Moreno-Loaiza]]></surname>
<given-names><![CDATA[O]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[A case report of intramyocardial bridge on right coronary artery]]></article-title>
<source><![CDATA[Medwave]]></source>
<year>2018</year>
<volume>18</volume>
<numero>8</numero>
<issue>8</issue>
</nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[De la Torre Fonseca]]></surname>
<given-names><![CDATA[LM]]></given-names>
</name>
<name>
<surname><![CDATA[Aroche Aportela]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Cabrera Rego]]></surname>
<given-names><![CDATA[JO]]></given-names>
</name>
<name>
<surname><![CDATA[Román Fernández]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
<name>
<surname><![CDATA[Pulla Quesada]]></surname>
<given-names><![CDATA[DM]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Puente muscular (milking) en arteria descendente anterior como causa de síndrome coronario agudo]]></article-title>
<source><![CDATA[CorSalud]]></source>
<year>2017</year>
<volume>9</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>45-9</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Peña Oliva]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Goire Guevara]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Salas Fabré]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Puente miocárdico largo en la arteria descendente anterior como causa de síndrome coronario agudo]]></article-title>
<source><![CDATA[CorSalud]]></source>
<year>2020</year>
<volume>12</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>227-31</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[CardinaliRé]]></surname>
<given-names><![CDATA[BA]]></given-names>
</name>
<name>
<surname><![CDATA[Olgiati]]></surname>
<given-names><![CDATA[FJ]]></given-names>
</name>
<name>
<surname><![CDATA[Ortiz]]></surname>
<given-names><![CDATA[LM]]></given-names>
</name>
<name>
<surname><![CDATA[Echazarreta]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Portis]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Puente miocárdico sintomático: ¿El paciente debe resignarse a los síntomas?]]></article-title>
<source><![CDATA[Insuf. card]]></source>
<year>2019</year>
<volume>14</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>64-9</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Camacho-Castillejos]]></surname>
<given-names><![CDATA[DP]]></given-names>
</name>
<name>
<surname><![CDATA[Clemente-Herrera]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Puente muscular miocárdico: causa de infarto agudo de miocardio en paciente sin factores de riesgo cardiovascular.]]></article-title>
<source><![CDATA[Med. Interna Méx]]></source>
<year>2017</year>
<volume>33</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>139-43</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Peral-Sánchez]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Porcar-Rodado]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Consideraciones anestésicas en los pacientes con presencia de puentes intramiocárdicos. The Milking syndrome]]></article-title>
<source><![CDATA[Rev Elect Anestesiar]]></source>
<year>2022</year>
<volume>14</volume>
<numero>6</numero>
<issue>6</issue>
</nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Borges-López]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Mares-Orozco]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Barón-Caballero]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Ochoa-Pérez]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
<name>
<surname><![CDATA[Castaño-Guerra]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Ayala-Hernández]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Miocardiopatía hipertrófica obstructiva medioventricular asociada a ectasia coronaria y trayecto arterial intramiocárdico]]></article-title>
<source><![CDATA[Rev Cuba Cardiol Cir Cardiovasc]]></source>
<year>2022</year>
<volume>28</volume>
<numero>3</numero>
<issue>3</issue>
</nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Reisvig]]></surname>
<given-names><![CDATA[ML]]></given-names>
</name>
<name>
<surname><![CDATA[Di-Matteo]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Squadroni]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Garmendia]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Sánchez]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[García]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Muerte súbita cardíaca asociada a puente miocárdico]]></article-title>
<source><![CDATA[Insuf Card]]></source>
<year>2019</year>
<volume>14</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>158-61</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Menares-Koppe]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Freire-Catalán]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Medina-De Pino]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Calderón-Avendaño]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Fuentes-Varos]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Infarto agudo al miocardio secundario a puentes intramiocárdicos, reporte de caso]]></article-title>
<source><![CDATA[CIMEL]]></source>
<year>2021</year>
<volume>28</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>26-30</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Medina Acuña]]></surname>
<given-names><![CDATA[DA]]></given-names>
</name>
<name>
<surname><![CDATA[Gabriaguez González]]></surname>
<given-names><![CDATA[LM]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Puente miocárdico como causa de infarto a repetición.]]></article-title>
<source><![CDATA[Rev. virtual Soc. Parag. Med. Int]]></source>
<year>2019</year>
<volume>6</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>76-80</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
