Open AccessMyocardial Bridging: A Review with Emphasis on Electrocardiographic Findings
Author(s) -
Rovai Daniele,
Di Bella Gianluca,
Pingitore Alessandro,
Coceani Michele
Publication year - 2015
Publication title -
annals of noninvasive electrocardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.494
H-Index - 48
eISSN - 1542-474X
pISSN - 1082-720X
DOI - 10.1111/anec.12242
Subject(s) - medicine , cardiology , chest pain , coronary vasospasm , myocardial bridge , ischemia , angina , coronary artery disease , myocardial bridging , coronary atherosclerosis , sudden cardiac death , vasospasm , electrocardiography , myocardial infarction , culprit , acute coronary syndrome , coronary angiography , subarachnoid hemorrhage
Background Myocardial bridging (MB) occurs when a segment of an epicardial coronary artery takes an intra– myocardial course, thus leading to systolic compression. Most myocardial bridges involve the left anterior descending artery and are observed in 14–35% of patients. Different pathophysiological mechanisms can induce symptoms secondary to myocardial ischemia: systolic coronary compression, diastolic dysfunction associated with aging and coronary atherosclerosis, LV hypertrophy, vasospasm, microvascular and endothelial dysfunction, plaque development proximal to the bridge. Methods We performed a literature review of MB, with a particular emphasis on electrocardiographic manifestations. Results Stable angina–like chest pain is the usual presentation and MB should be suspected in patients at low risk for coronary atherosclerosis which refer this symptom or which present myocardial ischemia at instrumental examinations. ECG changes are not specific for MB and resting ECG is often normal or presents ST segment anomalies. Exercise stress test often shows non specific signs of ischemia, conduction disturbances or arrhythmias which do not allow the distinction between myocardial bridging and other causes of myocardial ischemia; angina often appears during exercise, even in the absence of ECG changes. Myocardial perfusion deficits at scintigraphy are neither obligatory nor specific. Although the clinical significance of MB is still debated, MB has been associated with acute coronary syndrome, coronary vasospasm, and even sudden cardiac death. Conclusion Although MB may lead to myocardial ischemia during stress, its clinical presentation and electrocardiographic findings are not specific.