Chest pain and breathlessness query - LAD mild disease with segment of intra-myocardial bridging in mid LAD & possible Microvascular disease

[Mac_suki]

Does anyone have a myocardial bridge in the mid LAD and constant chest pain and frequent breathlessness?

[Milkfairy Heart Star]

Hi Mac_suki

That's quite a rare diagnosis

How was your condition diagnosed?

Are you based in the UK?

There is another forum member living with a myocardial bridge which can lead to microvascular angina too.

[Mac_suki]

Hi Milkfairy,

I was diagnosed with this at the BRI Bristol Heart Institute UK following angiogram.

Do you know if the forum member suffers with constant chest pain and breathlessness?

Thanks.

[Milkfairy Heart Star in reply to Mac_suki]

You might find this thread helpful

healthunlocked.com/bhf/post...

[mistymolly]

Hi sorry to hear that you also have a bridge, which is a nightmare to live with. Did you check out the thread the other member very kindly posted. Excellent group on Facebook with all the information about myths etc. I get all the symptoms you mention - chest pain breathlessness fatigue sweating weakness palpitations etc. Best of luck. You will need to find a cardiologist who has educated themselves in myocardial bridge. I think there is a Professor Marcus Flather in the UK who is sympathetic. Do not listen to anyone who tells you a myocardial bridge is benign because it isn't.

[Mac_suki in reply to mistymolly]

Thank you for your kind reply. I have checked out Facebook and found a MB group with lots of helpful info. Have also booked private cardiologist apt.

[mistymolly in reply to Mac_suki]

Check out the document under Announcements in the support group- excellent. There is also an excellent wickapedia article. Best of luck with the cardiologist. If he says MB is benign, hes not keeping up with latest research and doesn't know what he's talking about.

[Mac_suki in reply to mistymolly]

Thanks, which Facebook group has this announcement, there are several groups? thank you

[mistymolly in reply to Mac_suki]

I just approved new member. Was that you? myocardial bridge support group

[84green in reply to mistymolly]

Not yet!

[84green in reply to 84green]

Need to get myself on Facebook first. Saw you on YouTube though, very helpful description of your condition.

I’ll see how it goes with the consultant on Thursday. Have many questions for him and need to focus on properly noting and assessing his answers (after all, it’s what I’m paying him for!). Thanks again

[Mac_suki in reply to mistymolly]

I think that may be me! Is the profile pic a Red heart with MB written in the middle?

[mistymolly in reply to Mac_suki]

Yes 😊😊

[84green]

Hi Mac_suki. My recent CT angiogram result stated "Myocardial bridge is noted in the mid LAD." The cardiologist explained it as a condition I would have been born with that is usually benign but can be treated if symptoms develop. He suspected that any symptoms I might feel - breathlessness, dizziness, chest pain etc would be more likely due to the minimal/ mild narrowing noted in my arteries than by the MB.

Online information on this doesn't appear consistent - ranging from relatively harmless to being the cause of heart attacks during exertion and everything in between! That said, I'm trying not to over - read at the moment as I seem to have an unfortunate knack of reading symptoms and then sub consciously adopting them.

I also guess a difficulty is separating MB symptoms from those of narrowed arteries as they seem similar. I sometimes feel a nagging, almost muscular ache on the far left side of my upper chest (feels like nervous anxiety rather than pain) and some light headedness. Am exercising daily without a problem. I tend not to notice anything when I'm mentally busy, it happens when my mind starts focusing on it - if that makes sense.

I am seeing another consultant privately on Thursday and will discuss it again. Will be happy to share their comments with you if it might help.

Best wishes

[Mac_suki in reply to 84green]

Thank you so much, this is really helpful and exactly what I have been experiencing too! In fact my husband just asked if I wrote your reply for you! Also booked privately to see cardiologist on Thursday. Will be happy to share their comments with you too.

Hope all goes well for you on Thursday.

Best wishes

[mistymolly in reply to 84green]

Just wondering if you have had a diastolic FFR. Three main tests you need are cath with dffr, stress echo and CT scan. If you haven't had these, I would think your cardiologist isn't sure the bridge is causing your symptoms. Best of luck

[84green in reply to mistymolly]

Thanks. Only the CT cardio angiogram which noted the presence of the MB. Meant also to add that I have tried a GTN spray a few times - to no effect.

Feeling it at the moment but I’m sure it’s because it’s in my mind. Have a Pilates class later and can be sure I won’t feel it when I’m doing this. It really is odd!

[mistymolly in reply to 84green]

Some people find they are better with exercise. I think it helps circulation. I highly recommended you join the support group on Facebook and check out the document under announcements. There is also an excellent wickapedia article if you Google it. You really need a diastolic FFR because 80 percent of the blood flows through this artery during the relaxation phase. Hope this helps x

[84green in reply to mistymolly]

Thanks. Will let you know what the consultant says.

[mistymolly in reply to 84green]

You could bring the documents with you if it helps. People on the support group have been told it's not your bridge but went on to have unroofing surgery with the experts and got their lives back. Best of luck

[Milkfairy Heart Star in reply to mistymolly]

There is now research that is showing that FFR is only part of the picture.

It is also whether the microvascular blood vessels can respond appropriately.

Microvascular dysfunction can occur with a normal FFR

You can have a lower FFR however if the microvessels can respond then there maybe little myocardial ischaemia.

The Coronary flow reserve plays its part too.

Cardiac physiology is complex.

Unfortunately not all Facebook groups and google provide evidenced based information

This is a very good tutorial about myocardial ischaemia by Venk Murthy a leading US based Cardiologist worth a watch.

youtu.be/GjjCQ9NA5fA(Not working as expected?)

[84green]

As predicted, an hour of Pilates - some cardio, resistance and stretching and no pain/ discomfort at all. It really does feel that the more I read about and/ or think about it - it just appears, then goes again when I focus on something else.

[84green]

Hi Mac_suki. Well I saw the consultant yesterday - recommended to me by a nurse. I liked him and he was very patient and went through my CT cardio angiogram in details with what it means and the implications. He was reassuring that the medication and lifestyle are putting me on the right course to “arrest” the atherosclerosis in the arteries.

He said that the mild stenosis of my aortic valve was typical of someone my age, not serious and not likely to be causing symptoms.

In relation to my chest pains/aches, he was of the opinion that these might be muscular and/or anxiety - related. He emphasised that I needed a little time to get my head around the diagnosis (five weeks ago) and the consequent changes. My main pain is at the bottom of my rib cage, aggravated by particular movements and I am convinced muscular.

I asked about the MB which he said, in his opinion, isn’t generally a problem and he didn’t believe it was for me. He certainly wasn’t dismissive of it but that was his view based on my ecg, echo and MRI reports as well as symptoms.

He also said that MB’s were a lot more common than people realised. It took me 57 years to find out I had one! When they do occur, it is usually within the LAD. I didn’t really go into microvascular disease in any detail as time was limited and I had a list of question to ask based on my MRI.

He didn’t want to waste my time or money and has written a letter for my GP recommending a referral for a stress echo test. He said it wasn’t worth paying privately for one but it might help ease my anxiety. He was helpful and answered a follow up question via email straight away.

So, I think for now, I’m going to keep up with the exercise, diet and medication changes, try and relax and see where things go.

It seems years since I thought of anything other than my heart! My heart, brain and body would probably benefit from taking a few deep breaths.

Sorry, it’s not more definitive but I thought I’d share in any event.

Best wishes

[Mac_suki]

Thank you for sharing this 84green. My experience with my consultant was not as positive. Unfortunately he was dismissive of MB or MVD. So I am confused as when I came out of the angiogram he advised me and my husband that Microvascular disease was causing the pain and spams. He has put me on 4 heart meds, however stated there was nothing wrong with my heart as I only have mild CAD so I am very confused to say the least.

[Milkfairy Heart Star]

I suggest you ask for a second opinion from a Cardiologist who has some understanding of Microvascular dysfunction and Microvascular angina or is willing to learn.

One of the major problems patients with MVA and Vasospastic angina face is the lack of knowledge and recognition of the conditions.

Your Cardiologist's response to you reflects that they are not as upto date as perhaps they should be about MVA and VSA.

Myocardial bridges can lead to vasospasms in the small coronary blood vessels causing MVA.

[Kona514]

There is a mb group mentioned in these posts- the link is facebook.com/groups/Myocard... if you are interested. The best info is the files folder- a compilation of medical articles, docs familiar with MBs and MVD, and people who understand that myocardial can be the cause of cardiac problems, despite being regarded as common by cardiologists.

[Northernpaw]

That’s me! Chest pains for years, no clear diagnosis. Finally had an angiogram, 90% blockage in lower LAD D1 and myocardial bridge mid LAD.Stented in April 2020, it helped but chest pain is still present. I try to push through it. My latest Cardiologist (3rd one!) thinks the pain is related to Reflux and gave me PPI but nothing has changed.

I exercise regularly and watch my diet.