Myocardial Bridge

What is myocardial bridging?

Myocardial bridging is a condition where part of your coronary artery runs through muscle in your heart instead of over it. This bit of heart muscle that sits on top of part of your artery is what healthcare providers call a myocardial bridge.

In some cases, the muscle can press on the part of your artery that goes through it. This can make it hard for blood to move through the compressed area and get to your heart muscle.

Coronary arteries have an important job. They’re the blood vessels that bring oxygen-rich blood to your heart muscle. The muscles in your heart need oxygen just like any other part of your body.

If myocardial bridging occurs, it’s usually in the left anterior descending (LAD) artery. But it can happen in any of the arteries that bring blood to your heart.

How serious is a myocardial bridge?

Usually, a myocardial bridge doesn’t cause any harm. But when your heart muscle doesn’t get enough oxygen because of this condition, you may experience angina (chest pain).

How common is a myocardial bridge?

Researchers see myocardial bridge as a common but underestimated condition. Estimates vary widely depending on the method healthcare providers use to find myocardial bridges. Some scientists say 16% to 30% of people have myocardial bridging, based on angiograms.

What are the symptoms?

As people with myocardial bridging age or develop other medical conditions, some may develop symptoms. It can take years for symptoms to start.

Most people don’t have myocardial bridge symptoms. But you might have chest pain (angina) when physical activity or emotional stress makes your heart beat faster than usual.

Other symptoms are like those of a heart attack. Symptoms may include:

• Shortness of breath.
• Heart palpitations.
• Dizziness.

Always seek emergency treatment if you think you’re having a heart attack.

What causes myocardial bridge?

Myocardial bridging is a congenital condition. That means you have it at birth.

What are the complications?

Most myocardial bridge complications are rare, but can include:

• Myocardial ischemia (not enough oxygen reaching your heart muscle).
• Coronary vasospasm.
• Atherosclerosis (plaque buildup) near the myocardial bridge.
• Acute coronary syndrome (coronary artery disease).
• Ventricular arrhythmias (abnormal heart rhythms).
• Broken heart syndrome.
• Heart attack.
• Sudden cardiac death.

How is a myocardial bridge diagnosed?

A healthcare provider can diagnose a myocardial bridge with these tests:

• Coronary angiogram.
• Intravascular ultrasound (IVUS).
• Optical coherence tomography (OCT, a noninvasive scan).
• Coronary computed tomography (CT) angiogram.

A person may get tested because they have symptoms, or a provider may find the myocardial bridge when they’re looking for something else (incidentally).

How is a myocardial bridge treated?

Myocardial bridge treatment for people with symptoms may include medications, surgery or a minimally invasive procedure. Your provider will suggest the best option for you. Treatments may include:

• Medicine: Medications for myocardial bridge treatment may include beta-blockers or calcium channel blockers. Ivabradine is an alternate choice for certain people.
• Surgery: Depending on your anatomy, your myocardial bridge surgery may be a surgical myotomy (removing the bridge) or coronary artery bypass surgery (going around the blocked area). Providers choose myotomy to remove myocardial bridges that are shorter or shallower. Bypass surgery is better for longer or deeper myocardial bridges.
• Stent placement: Putting a stent inside your coronary artery is another option. The stent can hold the affected part of your artery open under the weight of the heart muscle pressing on it. This may let blood get through more easily. 

What can I expect if I have a myocardial bridge?

Like many people, you might not have symptoms of a myocardial bridge. In most cases, medicines help if you have symptoms. If medication doesn’t help your symptoms, you may need surgery to remove or bypass the muscle or a procedure to put in a stent.

How long myocardial bridge lasts

A myocardial bridge doesn’t go away unless you have surgery to remove it. But most people don’t need surgery.

What is the survival rate of myocardial bridging?

Most people with myocardial bridges have a good life expectancy and do well long-term.

The survival rate depends on whether you have other conditions. In one study, about 90% of people with myocardial bridges were alive 10 years after diagnosis. But people who also had coronary artery disease (CAD) had a lower survival rate.

How do I take care of myself?

Myocardial bridging has an association with a higher risk of atherosclerosis (plaque buildup in your arteries). Because of this, your provider will likely want you to manage other risk factors for it. This is true whether you have myocardial bridge symptoms or not. Avoiding tobacco products is a key factor in preventing atherosclerosis. Ask your provider for help with quitting smoking.

If you already have coronary artery disease, your provider will prescribe antiplatelet drugs and cholesterol-lowering medicine.

When should I see my healthcare provider?

It’s important to keep follow-up appointments with your provider. They’ll want to see you regularly to make sure you’re taking the right amount of medicine. You’ll also need follow-ups after a procedure or surgery.

Call 911 or your local emergency services number if you think you’re having a heart attack.

What questions should I ask my doctor?

Questions to ask your healthcare provider may include:

• How often do I need follow-up appointments with you?
• Do I need medicines or surgery?
• Why do you recommend the treatment you chose for me?

A note from Cleveland Clinic

It’s not easy to hear that your heart has something unusual about it. But for most people, a myocardial bridge isn’t a cause for concern. If you’re having symptoms, talk with your provider about which treatment is best for you. For certain treatments, like surgically removing a myocardial bridge, you may want to choose a facility that does a lot of these procedures. Providers there are likely to have a lot of experience with doing this type of operation.