IMR Press / RCM / Volume 17 / Issue 1-2 / DOI: 10.3909/ricm0814

Reviews in Cardiovascular Medicine (RCM) is published by IMR Press from Volume 19 Issue 1 (2018). Previous articles were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence, and they are hosted by IMR Press on as a courtesy and upon agreement with MedReviews, LLC.

Open Access Case Review
Forty Years of Chest Pain: A Case Report and Contemporary Review of the Diagnostic and Therapeutic Options for Myocardial Bridging
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1 Cedars-Sinai Heart Institute, Los Angeles, CA
2 The David Geffen School of Medicine at UCLA, Los Angeles, Los Angeles, CA
Rev. Cardiovasc. Med. 2016, 17(1-2), 69–75;
Published: 30 March 2016
A 48-year-old woman with 40 years of intermittent squeezing chest pain presented with worsening symptoms. Results of an ambulatory electrocardiogram, echocardiogram, and exercise treadmill were unremarkable. Persistent symptoms prompted a computed tomography coronary angiogram (CTCA) that revealed mid-left anterior descending artery myocardial bridging (MB) that was not physiologically significant by exercise single-photon emission CT. Conservative treatment was pursued. Anatomic MB is prevalent in a large proportion of the general population and are increasingly identified by CTCA. The majority are benign, physiologically significant bridging is uncommon, but accelerated proximal atherosclerosis can occur. β-blockers and nondihydropyridine calcium-channel blockers are the primary treatment options, with surgical myomectomy, coronary artery bypass, and stenting reserved for patients refractory to medical therapy with demonstrable ischemia. Head-to-head evaluation of nonpharmacologic therapies is needed. Intracoronary techniques provide simultaneous anatomical and physiological assessment but CTCA fractional flow reserve and hybrid positron emission tomography with concomitant spatial imaging systems are evolving as noninvasive alternatives.
Myocardial bridging
Myocardial bridge
Myocardial ischemia
Myocardial perfusion
Chest pain
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