A Clinical Approach to Diagnosis and Treatment of Left Anterior Descending Artery Myocardial Bridge

The muscle overlying the intramyocardial segment of an epicardial coronary artery is defined as myocardial bridge (MB). The clinical relevance of MBs is extremely heterogeneous, ranging from incidental finding in asymptomatic patients to different clinical manifestations such as stable or unstable angina, arrhythmias, Takotsubo syndrome or other major cardiovascular events. Moreover, patients can evolve from “asymptomatic carriers” to “symptomatic carriers” over time. In this setting, haemodynamic assessment is challenging and optimal therapy still a matter of debate. This review summarizes epidemiology, pathophysiology, diagnostic work-up (including both morphological and functional assessment) and treatment of patients with MB involving the left anterior descending artery, suggesting a pragmatic clinical approach.