Pathophysiological and Clinical Aspects of Myocardial Bridges

Coronary arteries are normally located on the epicardial surface of the heart (surrounded by adipose and loose connective tissue), can "plunge" into the thickness of the myocardium at different depths, and then again "appear" on the surface of the heart. The muscle that covers the intramural segment of the epicardial coronary artery is called the myocardial "bridge" (MB), and the artery extending into the thickness of the myocardium is called the tunnel. MB is the most common congenital pathology of the coronary arteries. MB occurs in about 1/3 of the entire population, but it does not always manifest itself in violation of heart perfusion and related symptoms: angina pectoris, vasospastic angina (Prinzmetalla), acute coronary syndrome, loss of consciousness, ventricular tachycardia, sudden death. This pathology is found in both women and men, but the target group remains in men 25–35 years of age, who experience clinical manifestations mainly during physical activity. According to autopsies, MB is found in 87 %, up to 5 % of them are hemodynamically significant. Among those who died suddenly, 25 % had MB. This topic is relevant because previously diagnosed with MB can prevent the development of the above pathological conditions and save the life of the patient. The article presents data on morphology, pathogenesis, clinical manifestations, diagnosis and treatment of myocardial bridges (MB). The role of this coronary vessel pathology in the emergence of vasospastic angina (Prinzmetal) and sudden cardiac death in young, mainly male patients has been revealed. The pathophysiological role of CO2 levels in the blood and its relationship to the clinical manifestations of the muscular bridges were also analyzed.