Myocardial bridge

A congenital heart anomaly involving the coronary arteries

Myocardial Bridge

A myocardial bridge is a congenital anomaly of the coronary arteries where a segment of a coronary artery tunnels through the myocardium, the muscular wall of the heart, instead of resting on its surface. This condition is most commonly found in the left anterior descending artery (LAD), but can occur in other coronary arteries as well.

Diagram of a myocardial bridge

Anatomy and Physiology

In a typical heart, the coronary arteries lie on the surface of the heart, supplying oxygen-rich blood to the heart muscle. In the case of a myocardial bridge, a portion of the artery dips into the myocardium and is "bridged" by heart muscle. During systole, when the heart muscle contracts, the tunneled segment of the artery is compressed, which can potentially reduce blood flow.

Clinical Significance

While many individuals with a myocardial bridge are asymptomatic, some may experience symptoms such as angina, myocardial ischemia, or even myocardial infarction. The compression of the artery during systole can lead to decreased blood flow, particularly during periods of increased heart rate or demand.

Symptoms

Symptoms associated with myocardial bridges can include:

• Chest pain or angina
• Palpitations
• Dyspnea (shortness of breath)
• Syncope (fainting)

Diagnosis

Myocardial bridges are often diagnosed using imaging techniques such as:

• Coronary angiography
• Intravascular ultrasound (IVUS)
• Computed tomography angiography (CTA)

Treatment

Treatment for myocardial bridges depends on the severity of symptoms. Options include:

• Beta-blockers or calcium channel blockers to reduce heart rate and myocardial contractility
• Surgical intervention, such as myotomy, in severe cases
• Lifestyle modifications to reduce cardiac stress

Related Pages

• Coronary artery disease
• Angina pectoris
• Myocardial infarction
• Cardiac anatomy