Introduction
Myocardial bridging (MB) is a harmless congenital coronary anomaly where one or more of the coronary arteries pass through the heart muscle rather than lying on its surface. Exact prevalence of MB is uncertain; however, MB is expected to present in about one-third of adults to some extent. (1)
The amount of myocardial fibers traversing above the artery enables differentiation between superficial (1-2mm of myocardial) and deep (>2mm of myocardium) bridge; this differentiation is significant as the depth correlates with the amount of compression exerted in systole (1). MB has been linked with angina, arrhythmia, depressed left ventricular function, myocardial stunning, and early death after cardiac transplantation, and sudden death. (2)
Most people don’t have myocardial bridge symptoms and generally it is a benign condition but might have symptoms like chest pain during physical activity or emotional stress. Other angina like symptoms may include shortness of breath, palpitation and dizziness. (3, 4)
MB induces myocardial ischemia via various mechanisms, such as supply-demand mismatch, endothelial dysfunction, coronary micro vascular dysfunction and external mechanical compression. (5)