Myocardial Bridge: Symptoms, Diagnosis & Patient Care

What is myocardial bridge?

A myocardial bridge is a birth defect in which a part of a coronary artery — most often the left anterior descending (LAD) artery — runs through the muscle of the heart (myocardium) rather than on top of it, as it should.

What Occurs?

• The involved artery plunges into the heart muscle and is "bridged over" by a layer of heart muscle.
• During contraction of the heart (systole), this bridge has a tendency to compress the artery.
• In most individuals, the compression does not significantly impede blood flow.
• But in some individuals, this can cause symptoms.

Myocardial bridge symptoms

Most individuals with a myocardial bridge are asymptomatic. But in others — particularly if the narrowing of the artery is serious — symptoms may arise, especially with exercise or stress, when the heart pumps more rapidly and harder.

Common Symptoms:

• Chest pain or tightness (angina-like)
• Shortness of breath (dyspnea)
• Palpitations
• Fatigue    
• Dizziness or lightheadedness
• Fainting
• Heart attack
• Arrhythmias

Myocardial bridge chest pain

Chest pain is the most frequent symptom in individuals with a symptomatic myocardial bridge, even though many are asymptomatic.

Why Does It Cause Chest Pain?

• During systole (systolic muscle contraction), the bridged segment of the coronary artery is under compression.
• Typically, blood perfuses into the heart during diastole (when the heart is at rest).
• But during fast heart rates, like exercise or stress, diastole is shortened, and compression can be obstructive to blood flow.
• This results in transient ischemia (diminished oxygen supply), producing angina-like pain in the chest.

Myocardial bridge diagnosis

A myocardial bridge is usually found accidentally while testing for chest pain or other symptoms related to the heart, particularly when normal coronary artery disease is not diagnosed. Diagnostic Techniques:

Coronary Angiography (Invasive)

• Most prevalent old-fashioned technique
• Injects the dye into coronary arteries to observe blood flow
• Results: "Milking effect" or "step-down–step-up" appearance during both systole and diastole

CT Coronary Angiography (CTCA)

• Non-invasive but very precise
• Creates a 3D image displaying the artery passing through the heart muscle
• Best for bridge anatomical visualization

Intravascular Ultrasound (IVUS)

• Invasive procedure performed during angiography
• Gives detailed pictures of the artery wall and muscle compression
• May demonstrate how deeply the artery is buried in the myocardium

Fractional Flow Reserve (FFR) or iFR

• Measures blood pressure differences between the bridged segment and the rest of the artery
• Assists in determining how much the bridge obstructs blood flow

Stress Testing (TMT or Stress Echo)

• Detects evidence of ischemia (decreased blood supply) during exercise
• May cause symptoms or ECG changes in keeping with the compression associated with the bridge

Cardiac MRI

• Occasionally employed to assess myocardial perfusion and function
• Useful in complicated cases or when ischemia is suspected

Treatment for myocardial bridge

The majority of individuals with a myocardial bridge do not require treatment — particularly if they are asymptomatic. Treatment is to minimize symptoms and avoid complications if there is chest pain, palpitations, or shortness of breath.

Lifestyle Changes (First-line in mild cases):

• Avoid heavy lifting or strenuous activity
• Monitor stress
• Restrict alcohol and caffeine if they provokes symptoms
• Avoid medicines that cause the heart to beat faster (e.g., stimulants)

Medications

• Used when the bridge is causing symptoms such as angina or arrhythmias.
• Beta-blockers: ↓ Contractility and heart rate, decreasing artery compression during systole
• Calcium channel blockers: Relax the coronary arteries and decrease spasm
• Anti-anginal drugs (such as ranolazine): Enhance microvessel blood flow
• Avoid nitrates: Can exacerbate symptoms by dilating arteries and increasing compression

Surgical Options (If medication fails)

a. Myotomy (Surgical Unroofing)

• Surgeon incises the overlying muscle of the bridged artery
• Curative treatment for deep or extended myocardial bridges

b. Coronary Artery Bypass Grafting (CABG)

• Bypasses over the bridged artery
• Used sparingly, only when myotomy is not possible

c. Stenting (Controversial)

• A stent is inserted into the bridged portion
• Not typically recommended because it can lead to fracture, restenosis, or vessel injury from repeated compression

Follow-Up & Monitoring

• Scheduled follow-up with a cardiologist
• Periodic stress testing or imaging if symptoms change
• Watch blood pressure, heart rate, and new symptoms

Myocardial bridge causes

Myocardial bridge is mostly a congenital anomaly, which means it occurs at birth. It is not the result of lifestyle, diet, or environmental influences. Primary Cause:

Congenital developmental anomaly

• When a fetus is developing, rather than lying on top of the heart muscle, a segment of a coronary artery (most often the left anterior descending artery, or LAD) becomes embedded in the myocardium (heart muscle).
• The artery is then "tunneled" beneath a band of heart muscle, creating a bridge.

Causes / Associations: While the precise cause is not entirely clear, some associations can impact severity or symptoms:

• Genetics: May contribute to development of coronary arteries
• High heart rates: Can increase symptoms in individuals with a myocardial bridge
• Hypertrophic cardiomyopathy: Bridges occur more frequently in individuals with thickened heart muscle
• Age: Younger patients tend to have greater compression; symptoms could decrease with age
• Body development: Variation in muscular thickness or coronary anatomy may affect bridging

Myocardial bridge complications

Though most individuals with a myocardial bridge remain asymptomatic or untroubled by complications, in certain instances — particularly if bridging is extensive or deep — it may produce clinically significant issues. Possible Complications:

Myocardial Ischemia

• Temporary decrease in heart muscle blood supply
• Happens during exercise or stress, when the heart beats more strenuously
• May result in chest pain (angina) or tiredness

Arrhythmias (Abnormal Heart Rhythms)

• Resulting from disrupted electrical impulses from ischemic tissue
• May produce palpitations, dizziness, or syncope
• Occasionally, potentially life-threatening arrhythmias such as ventricular tachycardia

Myocardial Infarction (Heart Attack)

• Uncommon, but if there is prolonged or severe restriction of blood flow
• Typically precipitated during high-stress or exercise in undiagnosed patients

Sudden Cardiac Death (Very Uncommon)

• Typically in young athletes or deep bridges + arrhythmias
• Typically seen with exercise-induced ischemia

Coronary Artery Spasm

• The bridged artery can spasm, decreasing blood flow further
• May produce unpredictable chest pain at rest

Atherosclerosis Proximal to the Bridge

• This segment is subject to disturbed blood flow patterns
• Increases risk of plaque formation (atherosclerosis) in this segment

Best doctor for myocardial bridge

• Dr. Amit Kumar Chaurasia
• Dr. Naresh Trehan
• Dr. (Col) Manjinder Sandhu
• Dr. Rajneesh Malhotra

Myocardial bridge surgery recovery

If meds don't work and the symptoms won't go away, surgical intervention — typically myotomy (unroofing procedure) — can be done. Post-myocardial bridge surgery recovery is usually uneventful, provided there are no other cardiac conditions.Recovery Timeline:

Hospital Stay

• 3–7 days
• ICU for 1–2 days, then normal cardiac unit

Initial Recovery

• 2–4 weeks
• Rest, walking around the house, managing pain

Gradual Activity Resumption

• 4–6 weeks
• Light activities; do not lift heavy things or drive

Full Recovery

• 6–12 weeks
• Return to work, normal life, cardiac rehab as needed

Why Choose GetWellGo for Myocardial Bridge Treatment?

GetWellGo is regarded as a leading supplier of healthcare services. We help our foreign clients choose the best treatment locations that suit their needs both financially and medically.

We offer:

• Complete transparency
• Fair costs.
• 24 hour availability.
• Medical E-visas
• Online consultation from recognized Indian experts.
• Assistance in selecting India's top hospitals for Myocardial Bridge treatment.
• Expert cardiologist with a strong track record of success
• Assistance during and after the course of treatment.
• Language Support
• Travel and Accommodation Services
• Case manager assigned to every patient to provide seamless support in and out of the hospital like appointment booking
• Local SIM Cards
• Currency Exchange
• Arranging Patient’s local food