Myocardial Bridging: Does It Get Worse Over Time?

Myocardial bridging is a congenital condition in which a segment of a coronary artery passes through the heart muscle instead of lying entirely on the surface of the heart. In most cases, this condition remains stable and does not worsen over time. However, under certain circumstances, symptoms or related complications may gradually become more severe.

Understanding the Basics of Myocardial Bridging

During heart contractions, the affected coronary artery can become compressed by the overlying heart muscle. If the compression is mild, it typically doesn't interfere with blood flow and may not cause any noticeable symptoms. Many people with mild myocardial bridging live their entire lives without experiencing any issues.

Potential for Symptom Progression

In more severe cases, where the coronary artery becomes significantly compressed, it can lead to reduced blood flow to the heart muscle—a condition known as myocardial ischemia. This may result in symptoms such as chest pain (angina), shortness of breath, fatigue, or discomfort during physical activity, emotional stress, or heavy exertion. Although the structural condition itself usually doesn't progress, the symptoms can become more pronounced under certain conditions.

Impact of Coronary Artery Disease

One of the key factors that can lead to worsening symptoms is the development of coronary artery disease (CAD). People with myocardial bridging may be more prone to atherosclerosis—the buildup of plaque in the arteries—especially as they age or when risk factors such as high cholesterol, smoking, or diabetes are present. If atherosclerosis develops near the bridged segment, it can further narrow the coronary artery and exacerbate the effects of the myocardial bridge, increasing the risk of angina or even heart attack.

Association with Other Cardiovascular Conditions

Patients with myocardial bridging may also have other heart conditions, such as hypertrophic cardiomyopathy or chronic hypertension. These conditions can increase the thickness of the heart muscle, which may intensify the compression of the coronary artery during physical activity. As a result, individuals may experience more frequent or severe symptoms like chest pain or reduced exercise tolerance.

Managing Myocardial Bridging Effectively

While myocardial bridging itself typically doesn't worsen, managing underlying risk factors is crucial to preventing complications. Adopting a heart-healthy lifestyle, controlling blood pressure, maintaining healthy cholesterol levels, and avoiding excessive strain during exercise can help reduce the risk of symptom flare-ups. In some cases, medications or even surgical interventions may be recommended to relieve severe symptoms.