Myocardial Bridging in a 37-Year-Old Female Patient: A Case Report and Management Approach.

Myocardial bridging is a congenital coronary anomaly in which a segment of a coronary artery travels intramyocardially instead of on the epicardial surface. While often asymptomatic, myocardial bridging can occasionally result in ischemia or arrhythmias. We present the case of a 37-year-old woman with recurrent exertional chest pain and exercise-induced hypotension. Stress testing revealed mild anterior ischemia, and coronary angiography demonstrated a mid-left anterior descending myocardial bridge. Intravascular ultrasound confirmed extensive systolic compression with increased plaque burden at the bridged site. Medical therapy with vasodilators and beta-blockers was not tolerated due to adverse effects, and symptoms persisted. The patient underwent surgical unroofing of the bridged segment, which resulted in complete resolution of chest pain and improved exercise tolerance. This case highlights the role of advanced imaging in the diagnosis of MB and the importance of individualized management when medical therapy fails.