What makes a coronary myocardial bridge symptomatic?

The clinical significance of coronary myocardial bridging has been debated and different interventional strategies proposed. We discuss the case of a patient who presented with the recent onset of symptoms of exertional chest pain, diaphoresis, and electrocardiographic signs of acute anterior myocardial wall ischemia. Cardiac catheterization demonstrated a segmental high-grade narrowing of the mid left anterior descending coronary artery during systole consistent with bridging. Intravenous fluid resuscitation and calcium channel blockade resulted in normalization of his electrocardiogram and complete resolution of his anginal symptoms and coronary angiographic systolic narrowing.