Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients.

Podcast Summary

Introduction

Dr. Warrick Bishop, a cardiologist, author, and CEO of the Healthy Heart Network, hosts this episode to share insights from the Cardiac Society of Australia and New Zealand meeting held in Adelaide in August 2023. The episode focuses on helping people understand cardiovascular health conditions and prevention, with this particular installment exploring the lesser-known condition of myocardial bridges and its clinical significance.

Key Takeaways:

• Myocardial bridges occur in up to 20% of the population, where coronary arteries run through the heart muscle rather than over its surface as is typical.

• Blood flow in coronary arteries occurs primarily during the diastolic (relaxation) phase of the cardiac cycle, as the high pressures during systole (contraction) prevent adequate blood flow.

• In rare cases, myocardial bridges can cause angina-like symptoms by compressing arteries significantly enough to restrict blood flow during both systole and parts of diastole.

• Myocardial bridging is one cause of MINOCA (Myocardial Ischemia with Non-Obstructive Coronary Arteries), a condition diagnosed when patients exhibit angina symptoms despite no visible coronary artery blockages.

• MINOCA can present in patients as young as 10 years old and as old as 70, making it a condition across a wide age range.

• CT coronary angiography and intravascular ultrasound are effective diagnostic tools; compression greater than 10% on intravascular ultrasound indicates the myocardial bridge is likely causing symptoms.

• Surgical de-roofing procedures, which remove the overlying muscle to free the artery, are the definitive treatment for symptomatic myocardial bridges.

• Stent placement is ineffective for myocardial bridges, and coronary artery bypass grafting is not necessary for this condition.

• Standard angina medications such as beta-blockers, calcium channel blockers, and nitrates can provide symptom relief for patients with myocardial bridges.

• Dr. Bishop's previous belief that myocardial bridges were clinically insignificant was challenged by this presentation, highlighting the importance of continued medical education and updated understanding of cardiac conditions.