Chest pain? Bridging the gap in diagnosis

First described in the 18th century1 as a benign band of myocardial tissue overlying a segment of an epicardial coronary artery, myocardial bridging is characterised by systolic compression of the tunnelled segment and is most commonly located in the middle segment of the LAD. Incompletely understood, the underlying mechanism leading to symptoms and ischaemia may be related to decreased mean flow during diastole, reduced coronary flow reserve, or an increase in plaque formation proximal to the bridge.3 Increased sympathetic drive during stress or exercise probably facilitates ischaemia via increased myocardial contractility.4 Treatment consists of negative inotropic and/or chronotropic agents such as β-blockers or calcium channel antagonists.