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Clinically significant myocardial bridging

Barbara A Danek1, Kathleen Kearney1, Zachary L Steinberg2

  • 1Internal Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA.

Heart (British Cardiac Society)
|June 21, 2023
PubMed

Insights

Myocardial bridging, where coronary arteries run within the heart muscle, can cause ischemia in some patients. Invasive assessment is key to managing symptoms and guiding treatment, including surgery for refractory cases.

Area of Science:

  • Cardiology
  • Anatomical Pathology
  • Physiology

Background:

  • Myocardial bridging is a common coronary artery anomaly.
  • It involves an epicardial artery coursing intramyocardially, causing systolic compression.
  • Most patients are asymptomatic, but a subset develops ischemic symptoms.

Purpose of the Study:

  • To highlight the diagnostic challenge of identifying clinically significant myocardial bridging.
  • To emphasize the role of functional factors in exacerbating ischemia.
  • To guide the assessment and management of patients with myocardial bridging and ischemic symptoms.

Main Methods:

  • Review of existing literature on myocardial bridging and ischemia.
  • Emphasis on invasive physiological assessment in symptomatic patients.
  • Discussion of medical and surgical treatment strategies.

Main Results:

  • Myocardial bridging can lead to ischemia, particularly when associated with diastolic dysfunction or vasospasm.
  • Invasive physiology is crucial for determining the significance of myocardial bridging in symptomatic individuals.
  • Surgical coronary unroofing is an option for refractory cases.

Conclusions:

  • Determining the clinical relevance of myocardial bridging requires careful evaluation.
  • Invasive assessment is recommended for patients with unexplained ischemic symptoms.
  • Tailored medical therapy and surgical intervention are treatment options.

Keywords:
Cardiac Imaging TechniquesChest PainCoronary Vessels

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