The myocardial bridge: incidence, diagnosis, and prognosis of a pathology of uncertain clinical significance

• Published in: European heart journal supplements 2022-11, Vol.24 (Supplement_I), p.I61-I67
• Main Authors: Santucci, Andrea, Jacoangeli, Francesca, Cavallini, Sara, d’Ammando, Matteo, de Angelis, Francesca, Cavallini, Claudio
• Format: Article
• Language: English
• Subjects: CCC 2022 - State of the Art Cardiology Supplement Paper
• ISSN: 1520-765X; 1554-2815
• DOI: 10.1093/eurheartjsupp/suac075

The myocardial bridge (MB) is a common anomaly of the coronary tree, very often clinically silent. The artery typically involved is the left anterior descending in its proximal and/or middle portion. MB can cause ischaemia with various mechanisms, directly proportional to the degree of compression of the intra-myocardial tract, which impairs the coronary flow. It is a dynamic phenomenon that is affected by the adrenergic tone and is therefore often brought by physical exercise. MB, when symptomatic, often begins with angina from exertion; some patients have more severe conditions such as unstable angina or myocardial infarction. Coronary vasospasm related to MB-induced endothelial dysfunction can explain a number of cases that come to observation even with catastrophic pictures such as ventricular fibrillation caused by ischaemia. The diagnostic workup includes the non-invasive study using computed tomography angiography and the invasive study of the haemodynamic impact using pressure and Doppler guides. In symptomatic cases, drug therapy with a beta-blocker is enough to manage angina. When it fails, there is the option of coronary angioplasty or surgical treatment techniques.