Myocardial Bridge: Symptoms, Diagnosis, and Treatment Options

Myocardial bridge symptoms

Hello, Doctor.
Four years ago, I often experienced chest tightness, so I went to Cathay General Hospital for an examination.
The standard electrocardiogram (ECG) was normal, but the echocardiogram showed mitral valve prolapse.
During the exercise ECG, the attending physician noted some abnormalities and wanted to arrange for another type of test.
I requested to pay out of pocket for a 64-slice CT scan, which later revealed that I have myocardial bridge.
However, the attending physician said it was not serious and prescribed me Inderal to take when I felt uncomfortable.
The following year, I visited Wan Fang Hospital due to the same chest tightness.
The attending physician there said the standard ECG was normal, but the echocardiogram showed significant mitral valve prolapse.
I underwent 24-hour Holter monitoring twice; the first time raised suspicion of ischemia, and the second showed mild arrhythmia.
A nuclear medicine test indicated mild ischemic conditions, but the attending physician suggested it might be related to my myocardial bridge.
She also prescribed Inderal.
The next year, I noticed that after eating and climbing stairs, I felt strange sensations in my heart, as well as discomfort in my left shoulder and left arm, and a peculiar feeling behind my heart.
I returned to Wan Fang Hospital and saw a different physician.
Initially, she prescribed Inderal as well, but when I mentioned that I had undergone a nuclear medicine test at their hospital, she reviewed my medical records and told me I had a mild myocardial infarction.
She prescribed PROPRANOLOL 10MG, BOKEY 100MG, and ISOSORBIDE 10MG, stating that the mild myocardial infarction could be managed with medication.
However, I did not inform her about my myocardial bridge, and she did not conduct any further tests before making her conclusion.
Is this appropriate? She only scheduled an exercise ECG for two weeks later, and the report has not yet been released.
When I asked her about the implications, she did not provide much information, only saying we would discuss it after the exercise ECG results came in.
She also did not explain the purpose of these medications.
I am 30 years old, I smoke, and I do not exercise regularly.
I would greatly appreciate your guidance.
Thank you.

Xiao Chen, 30~39 year old female. Ask Date: 2011/05/19

Dr. He Dongjin reply Cardiology

Based on your description, it's advisable to quit smoking first.
At your age, the likelihood of angina is low, unless smoking is a contributing factor.
The overall symptoms sound like mitral valve prolapse, and the previous physician likely made a similar assessment, which is why they prescribed Inderal for treatment.
It's important to eliminate potential risk factors such as smoking and lack of exercise, as sometimes symptoms can arise from decreased cardiopulmonary function due to insufficient physical activity.
I recommend making lifestyle adjustments; of course, quitting smoking today won't lead to immediate improvement, but gradual changes can help.
The medication prescribed by the subsequent physician is for angina, but I suggest monitoring your condition and adjusting your lifestyle first.
If there is no improvement, then consider medication.
The angiogram should have provided a clear picture of your vascular condition; the remaining issue is how to take care of yourself.
Myocardial bridge itself is not a major concern, so there is no need to panic.
Smoking poses a much greater risk.
Changhua Hospital cares about your well-being.

Reply Date: 2011/05/19

More Info

Understanding myocardial bridge (MB) is crucial for patients experiencing symptoms such as chest pain, especially when there is a history of heart conditions. A myocardial bridge occurs when a coronary artery, typically the left anterior descending artery (LAD), runs through the heart muscle instead of resting on its surface. This can lead to compression of the artery during heart contractions, potentially causing ischemia (reduced blood flow) and related symptoms.

From your description, it appears that you have been experiencing recurrent chest discomfort, particularly during physical exertion or after meals, which could be indicative of myocardial ischemia. Your previous tests, including echocardiograms and nuclear medicine studies, have shown some abnormalities, including mitral valve prolapse and signs of ischemia. The fact that you have been prescribed medications such as propranolol (Inderal) suggests that your healthcare providers are trying to manage your symptoms and reduce the frequency of episodes.

Diagnosis and Symptoms
The symptoms associated with myocardial bridge can vary widely. Common symptoms include:
- Chest pain or discomfort, often described as pressure or tightness.

- Shortness of breath, especially during exertion.

- Palpitations or irregular heartbeats.

- Symptoms may worsen with physical activity, emotional stress, or after meals.

Your history of chest pain during activities like climbing stairs or after eating aligns with these symptoms. The intermittent nature of your symptoms, combined with the findings from your stress tests indicating ischemia, raises the concern for potential coronary artery disease (CAD) or the effects of the myocardial bridge.

Treatment Options
1. Medications: The use of beta-blockers like propranolol is common in managing symptoms related to myocardial bridge and ischemia. These medications help to reduce heart rate and myocardial oxygen demand, which can alleviate chest pain. Other medications, such as nitrates (like Isobide), can help improve blood flow by dilating blood vessels.

2. Lifestyle Modifications: Given your smoking history and lack of physical activity, lifestyle changes are crucial. Quitting smoking is one of the most significant steps you can take to improve your cardiovascular health. Additionally, incorporating regular exercise (under medical supervision) can enhance your overall heart function and reduce symptoms.

3. Further Evaluation: Since you mentioned that your recent physician did not consider your myocardial bridge in the context of your symptoms, it may be beneficial to discuss this with them. A follow-up with a cardiologist specializing in coronary artery disease or myocardial bridge could provide more tailored management. Further imaging studies, such as coronary angiography, may be warranted to assess the severity of the bridge and its impact on blood flow.

4. Monitoring: Regular follow-up appointments and monitoring of your symptoms are essential. If your symptoms persist or worsen, further intervention may be necessary, including potential surgical options if the myocardial bridge is significantly affecting your quality of life.

Conclusion
In summary, while myocardial bridges can be benign in many cases, they can also lead to significant symptoms and complications. Your current treatment plan should focus on symptom management, lifestyle changes, and close monitoring. It is essential to maintain open communication with your healthcare providers about your symptoms and any concerns you have regarding your treatment. If you feel that your concerns are not being adequately addressed, seeking a second opinion from a cardiologist may provide you with additional insights and treatment options.

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Suggestion: Please discuss the above situation further with your attending physician. Thank you. Wishing you good health!