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Contemporary Review of Myocardial Bridging for Internists

Muhammad Ajmal1, Bilaval Javed2, Saad Kubba1

  • 1University of Arizona, Sarver Heart Center, College of Medicine, Tucson; Banner University Medicine, Tucson, Ariz.

The American Journal of Medicine
|March 5, 2025
PubMed

Insights

Myocardial bridging, a congenital heart condition where arteries run within the heart muscle, can cause angina and increase cardiovascular risks. This review clarifies its diagnosis, mechanisms, and management for better clinical understanding.

Area of Science:

  • Cardiology
  • Congenital Heart Disease
  • Vascular Biology

Background:

  • Myocardial bridging is a congenital coronary anomaly where an epicardial artery tunnels within the myocardium.
  • Prevalence varies significantly by diagnostic method, from 0.5% in angiography to 80% in autopsy studies.
  • Historically deemed benign, recent evidence links it to angina and adverse cardiovascular events.

Purpose of the Study:

  • To review the clinical presentation and diagnostic modalities of myocardial bridging.
  • To elucidate the pathophysiological mechanisms underlying angina in myocardial bridging.
  • To propose an evaluation and treatment algorithm based on patient phenotype.

Main Methods:

  • Literature review of studies on myocardial bridging.
  • Analysis of diagnostic imaging techniques (autopsy, CT angiography, invasive angiography).
  • Synthesis of clinical data on symptoms, risk factors, and outcomes.

Main Results:

  • Myocardial bridging can manifest as chronic angina, even with non-obstructive coronary disease.
  • Associated with increased risk of major adverse cardiovascular events.
  • Underdiagnosis and underappreciation by clinicians contribute to suboptimal management.

Conclusions:

  • Myocardial bridging is an underrecognized cause of angina and cardiovascular events.
  • Accurate diagnosis and understanding of its mechanisms are crucial.
  • A phenotype-guided treatment approach is recommended for effective management.

Keywords:
Coronary artery diseaseEndothelial dysfunctionMyocardial bridgingSurgical unroofing of coronary artery

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