Images in Clinical Medicine

Myocardial Bridging

Holger Eggebrecht, M.D., and Stefan Möhlenkamp, M.D.

N Engl J Med 2003; 349:1047September 11, 2003

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Article

A 39-year-old man without a history of cardiac disease presented with left-sided chest pain. Myocardial infarction was ruled out. A subsequent stress test revealed no signs of myocardial ischemia. A contrast-enhanced electron-beam tomographic study revealed myocardial bridging of the middle segment of the left anterior descending coronary artery. Panel A shows a right anterior oblique view. There was systolic narrowing with a step-down, step-up phenomenon (arrow) affecting that segment of the artery, distal to the second diagonal branch (asterisk). Panel B shows a left anterior oblique view with maximal-intensity projection of the intramyocardial course of the artery toward the right ventricular subendocardium. The arrows show the step-down, step-up phenomenon, and the asterisk marks the distal branch. Ao denotes aorta. The patient was successfully treated with a beta-blocker.

Myocardial bridging occurs when muscle covers a segment of an epicardial coronary artery, frequently the left anterior descending coronary artery; the segment coursing within the myocardium is called a tunneled segment. Systolic vessel compression and delayed diastolic relaxation may impair coronary blood flow and result in chest pain similar to that of angina. Usually, myocardial bridging is a benign, congenital condition with a favorable long-term outcome; infrequently, it may be associated with myocardial infarction, conduction disturbances, and even sudden death. Negative inotropic and chronotropic medications, such as beta-blockers or calcium antagonists, are considered first-line therapy.

Holger Eggebrecht, M.D.
Stefan Möhlenkamp, M.D.
University Hospital Essen, D-45122 Essen, Germany

Citing Articles (3)

Citing Articles

1. 1

   Guang-Ming Lu, Long-Jiang Zhang, Hua Guo, Wei Huang, Reto D. Merges. (2008) Comparison of Myocardial Bridging by Dual-Source CT With Conventional Coronary Angiography. Circulation Journal 72:7, 1079-1085
   CrossRef

2. 2

   Y. Kodolitsch, O. Franzen, G. K. Lund, D. H. Koschyk, W. D. Ito, T. Meinertz. (2005) Coronary artery anomalies. Zeitschrift fr Kardiologie 94:1, 1-13
   CrossRef

3. 3

   (2003) Myocardial Bridging. New England Journal of Medicine 349:25, 2466-2466
   Full Text

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