Myocardial Bridging: pathophysiology, diagnosis and treated approaches

Abstract

Objective: Review the existing literature on MB, emphasizing its pathophysiology, clinical manifestations, diagnosis, and treatment. Literature review: Myocardial bridging (MB) is a congenital cardiac anomaly in which a portion of the cardiac muscle overlies a coronary artery, leading to a transient compression of the artery during systole. Despite being considered benign, some MB subgroups are associated with ischemic symptoms, complicating the differential diagnosis with coronary artery disease. Most MB patients are asymptomatic, with normal resting electrocardiogram results. Due to the heterogeneity of MB's anatomical and functional characteristics, evaluation should also include functional and physiological factors. There are no specific guidelines for treating asymptomatic MB patients, however, periodic monitoring and modification of associated risk factors are highlighted. In symptomatic patients, although scientific evidence is limited, beta-blockers have been considered first-line drugs due to their negative chronotropic and inotropic effects. Final considerations: Understanding the anatomical peculiarities and diverse clinical manifestations of MB, as well as the limitations and potentialities of different available diagnostic methods, is crucial for the proper clinical management of this condition.