ABSTRACT
A 48-year-old woman with 40 years of intermittent squeezing chest pain presented with worsening symptoms. Results of an ambulatory electrocardiogram, echocardiogram, and exercise treadmill were unremarkable. Persistent symptoms prompted a computed tomography coronary angiogram (CTCA) that revealed mid-left anterior descending artery myocardial bridging (MB) that was not physiologically significant by exercise single-photon emission CT. Conservative treatment was pursued. Anatomic MB is prevalent in a large proportion of the general population and are increasingly identified by CTCA. The majority are benign, physiologically significant bridging is uncommon, but accelerated proximal atherosclerosis can occur. b-blockers and nondihydropyridine calcium-channel blockers are the primary treatment options, with surgical myomectomy, coronary artery bypass, and stenting reserved for patients refractory to medical therapy with demonstrable ischemia. Head-to-head evaluation of nonpharmacologic therapies is needed. Intracoronary techniques provide simultaneous anatomical and physiological assessment but CTCA fractional flow reserve and hybrid positron emission tomography with concomitant spatial imaging systems are evolving as noninvasive alternatives.