Unraveling the Mysteries of Myocardial Bridging: Left Main Anomaly Resolving With Optimal Medical Management.

BACKGROUND

Myocardial bridging (MB), typically a benign anomaly, poses clinical challenges when involving the left main coronary artery (LMCA), increasing the risk of myocardial ischemia.

CASE SUMMARY

A 58-year-old man presented with stable angina and worsening exertional chest pain. Diagnostic work-up, including coronary angiography, intravascular ultrasound, and computed tomography angiography, confirmed LMCA MB with significant flow obstruction. A tailored pharmacologic regimen involving beta-blockers and calcium antagonists led to complete symptom resolution over 6 months.

DISCUSSION

Although MB often lacks symptoms, cases affecting the LMCA require careful assessment due to potential ischemic complications in broader territories. This case highlights the importance of comprehensive imaging and functional evaluation in managing MB and supports pharmacologic management over invasive procedures when feasible, aligning with recent literature advocating conservative treatment outcomes.

TAKE-HOME MESSAGE: Accurate diagnosis and personalized medical management are crucial in MB cases even if involving critical coronary arteries such as the LMCA.