Myocardial bridge

Diagnosis

A myocardial bridge may be found during a test for chest pain or another heart condition. Your healthcare professional may do a physical exam and ask about your symptoms. You may have tests to check the heart and look for other conditions that may cause similar symptoms.

Tests

Tests used to help diagnose a myocardial bridge include:

• Electrocardiogram (ECG). This quick test records the electrical activity of the heart. It shows how the heart is beating. Sticky patches with sensors called electrodes attach to the chest and sometimes the arms or legs. Wires connect the patches to a computer, which prints or shows results. An ECG can help diagnose irregular heartbeats.
• Exercise stress tests. These tests often involve walking on a treadmill or riding a stationary bike while a care team checks heart activity. Exercise tests can show how the heart responds to physical activity. If you can't exercise, you might get medicines that affect the heart like exercise does.
• Stress echocardiogram. An echocardiogram uses sound waves to create pictures of the heart. This common test can show blood flow through the heart and heart valves. A stress echocardiogram is done with intense exercise to check how the heart responds to physical activity. A healthcare professional takes baseline images before you start to exercise. Then more are taken afterward.
• Coronary angiogram. This test uses X-rays and a substance called contrast to look at the heart's blood vessels, called the coronary arteries. It can show how a coronary artery changes as the heart beats.
• Coronary CT angiogram (CCTA). This test uses a computerized tomography (CT) machine and contrast to show detailed pictures of the coronary arteries. It can show the location, length and depth of a myocardial bridge.
• Intravascular ultrasound (IVUS). This test uses sound waves to create images showing the inside of the artery. A healthcare professional guides a thin tube called a catheter through a blood vessel to the coronary artery. Sound waves are used to create pictures of the inside of the artery.

A myocardial bridge can be described by:

• Where it occurs.
• How long and deep the tunneled artery is.
• How much the artery is squeezed during a heartbeat.

You may have other tests depending on the symptoms and what conditions the healthcare team needs to rule out.

Treatment

Most people with myocardial bridges don't need treatment. If a bridge is found by chance and is not causing symptoms, you may only need regular health checkups.

If a myocardial bridge is causing symptoms, the goal of treatment is to ease them. Treatment depends on whether tests show reduced blood flow and whether you have other heart conditions. Treatment usually starts with medicines to control the heartbeat. If medicines aren't enough to improve symptoms, surgery may be an option for some people.

Medicines

Medicines used to manage myocardial bridging symptoms include:

• Beta blockers. These medicines slow the heart rate and help relax the heart muscle and blood vessels. Together, these effects can lessen squeezing on the tunneled artery. These medicines are often the first treatment option for myocardial bridge symptoms.
• Calcium channel blockers. Some calcium channel blockers used for myocardial bridging slow the heart rate. Calcium makes the heart and arteries squeeze more strongly. By blocking calcium, these medicines allow the blood vessels to relax and open.

Nitroglycerin and other nitrate medicines generally are not used to treat myocardial bridging because they can increase pressure on the tunneled artery and make symptoms worse.

Surgery

If you have a myocardial bridge that's reducing blood flow and your symptoms have not gotten better with medicines, you might need surgery. Types of surgery to treat a myocardial bridge or its symptoms may include:

• Supra-arterial myotomy. This procedure also is called surgical unroofing. The surgeon cuts the heart muscle fibers that are covering the tunneled coronary artery. This releases the artery from the surrounding muscle and lets the blood vessel remain more open during heart contractions.
• Coronary artery bypass graft (CABG) surgery. CABG is a type of open-heart surgery. Sometimes, a surgeon may create a new route for blood flow around the bridged part of the coronary artery.

Having surgery may help improve symptoms, but for some people symptoms can continue or come back after treatment.

Coronary angioplasty and stents may be done in some people whose symptoms don't get better with medicine. In angioplasty, a doctor uses a tiny balloon on a thin tube, called a catheter, to widen a clogged artery and improve blood flow. A small wire mesh tube called a stent may be placed to keep the artery open. This treatment also is called percutaneous coronary intervention. Coronary angioplasty and stent placement generally aren't preferred for myocardial bridging because stents in the bridged artery have been linked to complications and the artery may narrow again.

Prognosis

The outlook for most people with a myocardial bridge is very good. Most myocardial bridges don't cause serious health issues. Studies have not found a significant increase in overall death or cardiovascular death related to myocardial bridging.

Every person's situation is different. Having other heart conditions can affect your outlook. Talk with your care team about your heart and overall health to better understand your situation.

Self-care

If you have a myocardial bridge, ask your healthcare professional what level of exercise is safe for you. Having a myocardial bridge doesn't automatically mean you need to avoid physical activity.

If exercise causes chest pain, shortness of breath that is not usual, fainting or other concerning symptoms, stop the activity and discuss the symptoms with your healthcare professional before returning to strenuous exercise.

Both the American Heart Association and the American College of Cardiology say that competitive athletes who have myocardial bridges but no symptoms can participate in competitive sports. Athletes who have symptoms may need testing to see whether exercise reduces blood flow to the heart muscle. If testing shows reduced blood flow, treatment may be needed before returning to competitive sports.

It's also important to manage risk factors for coronary artery disease, such as high cholesterol, high blood pressure, diabetes and smoking. These don't cause the myocardial bridge, but coronary artery disease can happen along with myocardial bridging and may contribute to symptoms.

Preparing for your appointment

If you have symptoms that may be related to a myocardial bridge, you may be referred to a doctor who specializes in heart conditions, called a cardiologist. If your condition is complex or causes symptoms, you may see a team of specialists with expertise in coronary artery disease and heart surgery.

What you can do

Before your appointment, make a list of:

• Your symptoms, including when they started and whether they come and go.
• What you are doing when symptoms occur, especially whether they happen during exercise.
• How long symptoms last and what makes them better or worse.
• Other medical conditions you have.
• Any history of heart disease in your family.
• All medicines, vitamins and supplements you take, including doses.
• Results of any previous heart tests and where the tests were done.
• Questions you want to ask your healthcare professional.

Questions you may want to ask include:

• Is my myocardial bridge causing my symptoms, or could it be something else?
• Which coronary artery is affected?
• How long and how deep is the myocardial bridge?
• Does testing show that the bridge is reducing blood flow to my heart?
• Do I need treatment?
• What medicines might help?
• Are there medicines I should avoid?
• Is it safe for me to exercise?
• Should I restrict activity or competitive sports?
• When might surgical unroofing be considered?
• What are the benefits and risks of surgery?
• How often do I need follow-up?

What to expect from your doctor

Your healthcare team may ask you many questions, including:

• When did your symptoms begin?
• Do your symptoms come and go?
• How bad are they?
• Where do you feel chest pain or pressure?
• Do symptoms occur when you exercise?
• Have you ever fainted during exercise?
• Do you feel your heart racing or skipping beats?
• What makes your symptoms better or worse?
• Have you had previous heart tests?
• Do you have coronary artery disease or another heart condition?
• What medicines do you take?