Myocardial bridging

Defined as a segment of a major epicardial coronary artery that runs into the myocardial muscle.

Usually a benign incidental finding.

Can cause angina, arrhythmias, ischemia, infarction and death if it becomes a hemodynamic significant lesion.

Treatment beta-blockers or calcium channel blockers.

Nitrates and isotropic agents are avoided because they can augment systolic compression of the bridged vessel.

Incidence approximately 0.5-12% as discovered on coronary angiography studies.

Most cases no hemodynamic significance is present.

During systole partial or total occlusion of the vessel is present.

Arterial compression that occurs is dependent on heart rate.

Tachycardia can increase ischemia by compression of the vessel during systole.

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