A Tough Bridge to Cross: Myocardial Bridging Associated With Dehydration-Induced Ischemia in an Endurance Athlete

Myocardial bridging is a term used to describe an anatomic anomaly where an epicardial artery courses under an overlying myocardial "bridge." This condition has rarely been associated with exercise-induced ischemia or other cardiac events. Here, we describe a case of an endurance athlete who presented with evidence of acute myocardial injury after developing chest pain during participation in a marathon. Further evaluation revealed myocardial bridging involving the left anterior descending coronary artery (LAD) as the likely cause of her symptoms. In elite athletes, exercise-induced cardiac remodeling combined with the underlying pathophysiology of myocardial bridging puts them at an increased risk of experiencing a cardiac event and presents unique challenges in management and shared decision-making, as these patients often desire to continue athletic competition at a high level. In this case, various strategies were explored to manage this condition in collaboration with the patient to accomplish this goal. Ultimately, medical management was utilized in conjunction with emphasizing adequate hydration while providing the patient with objective parameters to guide her endurance training. Through describing cases where myocardial bridges (MB) cause significant symptomatic manifestations such as this one, we can hope to better understand this condition's pathophysiology and identify the most practical ways to approach its management.