Discussion of Myocardial bridging
- AKA tunneled artery.
- Myocardial bridging is a congenital anomaly characterized by myocardial encasement of a coronary artery segment, which normally courses epicardially.
- Symptoms usually do not develop before the third decade of life.
- It is clinically important because of its association with myocardial ischemia and secondary complications
- Myocardial bridges are mostly seen on the LAD mid segment.
- Multiple muscle bridges can involve either the same vessel or different coronary arteries and their branches.
- Several mechanisms have been postulated to explain ischemia resulting from myocardial bridging of a coronary artery, including vasospasm and systolic kinking of the artery that results in direct physical damage to the underlying endothelial cells.
- There is no need for treatment in asymptomatic patients.
- In symptomatic cases, the primary step is medical treatment. This includes ß-blockers, calcium channel blockers, and antiplatelet agents
 Imaging Findings for Myocardial bridging
 CT and MRI
- Myocardial encasement of a coronary artery segment