For a year and a half I've been having frequent episodes of dull aches (left inner chest), flutters in chest, breathlessness when being active and alot of the time I just have no energy, of late I've been experiencing the dull ache on rest, anyway I've had a CT Angiography it showed clear arteries, but it did show a suspected bridge! I had my microvascular review a few weeks ago and now I am on a waiting list for a CT catheterisation,
Has anyone else experienced similar who also has a bridge , the cardiologist who I seen dismissed the bridge straight away.
Regards x
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Bannachoc
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I had a MINOCA (myocardial infarction in non obstructed arteries) as a result of my bridge spasming in January 2022. I have no obstructions to my arteries and the bridge is thought to be the cause of a rarer type of angina called vasospastic angina that I have.
A myocardial bridge is one or more arteries that tunnel through the heart muscle. There are different types of bridges, superficial and deep bridges. Deep muscle bridges seem to cause more symptoms than superficial bridges.
Symptoms are commonly angina, as the artery becomes compressed and reduces blood flow to the heart. I feel my angina in the middle and more right hand side of my chest, upper back and in my arms. I am now feeling my spasms in my throat and in my ears. Though vasospastic angina is usually felt at rest and early hours of the morning, mine have progressed and I now have moderate to severe episodes in the day.
Other symptoms are breathlessness, syncope, fatigue, nausea, and arrhythmias.
To understand if and how the bridge is affecting you, specialised testing is often recommended in the form of an IVUS with dobutamine. Currently, in the U.K., there is a doctor based in London, Hammersmith which carries out this specialised testing on the bridge. He can determine the type of bridge that you possibly have and the extent to which it is causing compression/restricting blood flow. I have not had this testing as it has not been deemed necessary as of yet due to a specialist in INOCA (ischaemia in non-obstructed arteries) conditions, as well as other cardiologists not being approving of this right now.
Some seek relief through unroofing surgeries where the bridge is removed from under the heart muscle. This type of surgery can be a hit and miss. For some, it immediately improves symptoms and they can go on to do things with minimal pain and other symptoms whereas for others, post-op complications can make recovery harder and may not make a significant difference to their symptoms. This is not a surgery that is commonly performed in the U.K. but there are a few hospitals that do it which I have the names of. Many prefer to go abroad to have the surgery as there tend to be more experienced surgeons in unroofing available.
Medication is usually the first line of treatment. Beta-blockers, calcium channel blockers, a possible nitrate and statin are some of the ways in which symptomatic bridges can be treated. Nitrates are a hit and miss medication. Some find that it helps, whereas others do not feel a difference or it makes their symptoms worse. I always suggest that close monitoring is a good idea for bridge patients who trial nitrates for angina/chest pain relief.
I have had my bridge dismissed many times than I can count, and I have also been treated by physicians who do not know what a myocardial bridge is. Many medical physicians consider the bridge harmless as there is only a minority that are symptomatic from it. As a result, this affects the care we receive from them.
An MB is associated with not only coronary spasms, but also myocardial infarction (heart attack), microvascular dysfunction, unstable angina, and in some severe but rare cases, sudden cardiac arrest. Therefore, it is something which you should push with your cardiologist or doctor to get further testing on. The specialist in London does see patients on the NHS, though it might be a bit of a wait. You can ask your GP to refer you to this specialist.
There are some articles and information below that you may find useful.
Yes I have experienced similar as I have a bridge on my LAD and continue to get symptoms of angina and I am sorry to hear you are too as I would NOT wish a symptomatic bridge on anyone. Daily exertional and emotional angina with recently increased flip flopping sensation which I am awaiting investigation. There is no reprieve from this and makes daily life difficult, rest is key but that’s becoming hard too especially with the flip flop sensations.
I too was dismissed early on and it can be very demoralising but you known your body and what you are feeling so stick to your guns and persevere in getting answers. It’s just a difficult one as doctors are taught bridges are benign.
Bridges can be symptomatic although rare in their own right without having other issues but yes they also can cause or co exist with other issues like microvascular, vasospasms, arrhythmia.
The angiogram with dobutamine is key to getting a clearer diagnosis as well as measurement of the bridge and assessing blood flow rate - CT scans I think from research tend to underestimate - it did in my case. My bridge is 2cm long and 24mm deep, with pressure drop of 0.70 on dobutamine test. I’ve been cleared of microvascular issues through several tests and I don’t fit the profile for vasospasms.
I saw the mentioned London cardiologist and I thoroughly recommend them and worth the wait of a referral. They work NHS and private. I had to travel but it was worth it.
I have no meds that work despite several attempts and GTN are deliberately not prescribed. GTN, isosorbide mononitrate, dilitizem and ranaolazine make things worse for me but we are all different. I can’t have Beta Blockers as I’m asthmatic.
Surgery is not an option (as well as research indicating that unroofing is not suitable for bridges deeper than 5mm) as surgeon felt could not be done with any assurance of being successful let alone relieve symptoms.
Do you know what they will be testing for at the Ct catheterisation and what meds they will use? Adenosine? dobutamine?
It will help with a definitive diagnosis which for me from mental health perspective helped me accept things (although still working on this) and get acknowledgment.
The most important thing is stick to your guns, you know your body and what you experience and feel, don’t let anyone gaslight you or put it down to “just” anxiety (I got that one very early in) and keep at them till you get answers. Unfortunately The time you feel at your lowest and in pain is the time you have to push for answers.
wish you all the best and very much interested to hear how you get on.
I too have a myocardial bridge that is symptomatic from time to time. I recently ended up in A and E again. Like others have mentioned doctors opinions seem to vary from concern to dismissive. The symptoms are real and not in your head as some doctors imply. Try not to be fobbed off and continue to tell them exactly what you are experiencing. Not much more to add to the really great responses earlier. You are not alone, good luck and hope things improve.
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