How does LAD bridging impact heart health and symptoms?

Question

Hello doctor,

I am a 38-year-old female diagnosed with SVT (supraventricular tachycardia) on Holter monitoring twice, and I was treated with beta-blockers, which helped manage the condition. I also experience occasional chest pain that radiates to the jaw and collarbone, sometimes with a pulsing sensation.

A few months ago, an intense heartbeat was noticeable to others. An electrophysiology study (EPS) did not reveal any abnormal arrhythmia. CT (computed tomography) angiography showed Type III LAD myocardial bridging.

Recent tests include:

ECG showing anterior ischemia and anterolateral ischemia.
2D echo indicating stage I diastolic dysfunction.
Treadmill stress test showing stress-induced ischemia.

Currently, I am experiencing intermittent chest pain, difficulty breathing (feeling as if breathing is stuck), sleeplessness due to breathing difficulties, waking up with a pulsing chest pain, fatigue, and inability to engage in physical activity.

Could you help me understand my condition more clearly so I can manage it effectively?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and can understand your concern.

I have reviewed the information you have provided, and I would like to offer some clarification regarding your condition.

Your CT angiogram shows no evidence of coronary artery disease, which is reassuring. While I do not have the full report, I understand that the key finding is LAD (left anterior descending) bridging. This refers to a section of your left anterior descending artery (LAD), a major vessel supplying blood to the heart, running through the heart muscle (myocardium) instead of sitting on its surface.

In most cases, LAD bridging is a benign anatomical variation and does not cause symptoms or problems. However, in rare instances, it can lead to chest pain, especially during periods of increased heart rate, such as exercise or stress. This is because the heart muscle may compress the artery during these times, restricting blood flow.

To determine if LAD (left anterior descending) bridging is contributing to your symptoms, further investigation may be needed. A myocardial perfusion scan could help identify areas of reduced blood flow (ischemia), especially when you are not on medications that could mask these findings.

More advanced imaging options, such as cardiac PET (positron emission tomography) scans or MRI (magnetic resonance imaging), can also provide a clearer picture of any ischemia. In some cases, invasive procedures like angiography and FFR (fractional flow reserve) measurement may be used to directly visualize blood flow and assess whether the bridging is significantly affecting blood supply.

If ischemia is identified and linked to the LAD (left anterior descending) bridging, initial treatment typically involves beta-blockers to slow the heart rate, allowing the heart muscle more time to receive adequate blood flow and reducing symptoms. If medication alone is not effective, more invasive interventions, such as stenting or surgery, might be considered.

I hope this answers your query.

Please let me know if I can assist you further.

Thank you.