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Reviews in Cardiovascular Medicine  2016, Vol. 17 Issue (1-2): 69-75     DOI: 10.3909/ricm0814
Case Review Previous articles | Next articles
Forty Years of Chest Pain: A Case Report and Contemporary Review of the Diagnostic and Therapeutic Options for Myocardial Bridging
Emily Tat1, Richard Cheng1, Jeffrey S. Helfenstein1, 2
1 Cedars-Sinai Heart Institute, Los Angeles, CA
2 The David Geffen School of Medicine at UCLA, Los Angeles, Los Angeles, CA
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A 48-year-old woman with 40 years of intermittent squeezing chest pain presented with worsening symptoms. Results of an ambulatory electrocardiogram, echocardiogram, and exercise treadmill were unremarkable. Persistent symptoms prompted a computed tomography coronary angiogram (CTCA) that revealed mid-left anterior descending artery myocardial bridging (MB) that was not physiologically significant by exercise single-photon emission CT. Conservative treatment was pursued. Anatomic MB is prevalent in a large proportion of the general population and are increasingly identified by CTCA. The majority are benign, physiologically significant bridging is uncommon, but accelerated proximal atherosclerosis can occur. β-blockers and nondihydropyridine calcium-channel blockers are the primary treatment options, with surgical myomectomy, coronary artery bypass, and stenting reserved for patients refractory to medical therapy with demonstrable ischemia. Head-to-head evaluation of nonpharmacologic therapies is needed. Intracoronary techniques provide simultaneous anatomical and physiological assessment but CTCA fractional flow reserve and hybrid positron emission tomography with concomitant spatial imaging systems are evolving as noninvasive alternatives.
Key words:  Myocardial bridging      Myocardial bridge      Myocardial ischemia      Myocardial perfusion      Chest pain     
Published:  30 March 2016     

Cite this article: 

Emily Tat, Richard Cheng, Jeffrey S. Helfenstein. Forty Years of Chest Pain: A Case Report and Contemporary Review of the Diagnostic and Therapeutic Options for Myocardial Bridging. Reviews in Cardiovascular Medicine, 2016, 17(1-2): 69-75.

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