Myocardial Bridge in High School Athlete With Exertional Symptoms: Innocent Bystander or Major Player?

Background Myocardial bridge (MB) is largely considered a benign condition, though may lead to myocardial ischemia due to coronary vessel compression. It is a known cause of sudden cardiac arrest/death in young athletes. Case summary A 16-year-old male athlete with asthma presented with exertional dyspnea, chest tightness, and tachycardia following 3-mile races. Echocardiogram showed a small atrial septal defect and normal coronary artery origins. CTA demonstrated a left anterior descending MB. Stress CMR had no inducible perfusion defects. Cardiac catheterization for intracoronary flow assessment demonstrated compromised coronary flow distal to the MB with compression on IVUS. MB surgical unroofing allowed safe return to competition. Discussion Exhaustive work-up and invasive assessment of intracoronary flow is invaluable to determine significant compression of a MB causing ischemia in athletes with exertional symptoms. Take Home Message Exertional symptoms in athletes should be considered for advanced imaging to exclude significant lesions that compromise coronary flow.