Ask a Texas Heart Institute Doctor
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Question:
Can a myocardial bridge cause cardiac symptoms? I'm a 34 year old male, good shape, no family history of problems. For 3 years I've been having left side chest pain, left arm weakness/pain and pain under my shoulder blade. I've had echo, nuclear stress and 64 slice CT scans. All were normal except for an "insignificant myocardial bridge". I've also been to many specialists (gastro, pulmonary) and had many tests (endoscopy, chest CT, neck/shoulder/back MRI, and even a test with needles in my back). All results were normal. I read some doctors believe bridges are insignificant. Is this something that could be causing my pain? Other symptoms are lightheaded, palpitations, trouble getting a deep breath which I believe are all anxiety. It's not a bend over pain, it comes and goes -- hurts a week, then gone for several. I would appreciate any kind of help.
submitted by Brian, from Alabama, 1/9/09
Answer:
by Texas Heart Institute cardiovascular surgeon, William E. Cohn, MD 
A myocardial bridge is a band of heart muscle present since birth that lies on top of a coronary artery, instead of under it like it's supposed to. As you probably know, the heart is a large hollow muscle that squeezes every second or so to circulate blood through the body to provide oxygen and nutrients for all the vital organs. Because it works so hard, the heart also needs lots of oxygen and nutrients, and it delivers these back to itself through the coronary arteries. These arteries are about as big around as pencil lead and run over the surface of the heart. At various intervals, they give off smaller branches that dive into the heart muscle. In some patients, a large surface artery forms in such a way that a short portion dives beneath the surface of the heart. In this circumstance, the artery just before the diving segment and just after the diving segment lie on the surface of the heart, as they should. The band of muscle that overlies the diving segment is commonly referred to as a "bridge".
No one really knows how common bridges are, since the majority of patients with them are asymptomatic. Occasionally however, patients may develop myocardial ischemia as a result of a myocardial bridge. Myocardial ischemia describes the situation where a portion of the heart muscle isn't getting enough blood supply. With a myocardial bridge, this can be caused by the bridge "tightening down" during heart muscle contraction (when the heart beats), pinching the artery and decreasing blood flow. Even though most of the flow down normal arteries occurs between heart beats, this can cause a decrease in flow down the coronary artery in some situations. Myocardial ischemia can present in a number of different ways including chest pain, tightness, pressure or heaviness, pain in the left arm or jaw, shortness of breath, or fatigue. In up to one third of patients, however, there are no warning symptoms even though the heart is not getting enough blood supply.
There are a number of different tests that can be done to determine if a myocardial bridge is causing problems in a given patient. Most of these rely on an assessment of perfusion, or blood delivery, to the various parts of the heart during exercise and at rest. In patients with symptoms felt to be caused by ischemia due to a myocardial bridge, there are a number of very successful therapies that can provide relief, ranging from medical to catheter treatment to surgery, depending on the specifics of the individual case.
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Updated January 2009
