Dr. Roach: Pregnant woman in spin class might have myocardial bridging

Dear Dr. Roach: I read your recent column about the 30-year-old pregnant woman who had a “heart attack” while working out in a spin class. She fell into a coma and was found to have a “congenital heart defect.”

It seems to me that she likely has myocardial bridging, a congenital condition with the heart muscle wrapping around a coronary artery rather than under the vessel. When exercising, especially at peak effort, myocardial bridging tightens around the artery like a boa constrictor, cutting blood flow and provoking angina, shortness of breath, palpitations and even cardiac arrest.

This bridging is quite common. One in four people have some bridging, usually thin, partial bridges that are less than 1 mm thick, which don’t cause symptoms. Thicker and deeper bridging, around 2-3 mm thick, completely wraps around the vessel and can strangle the coronary artery, causing angina, heart attack or even sudden death.

The young woman who had the cardiac arrest might have had myocardial bridging, which became more damaging due to the increased cardiac output of pregnancy, combined with the peak exercise at her spin class. As contractility increased, the bridging twisted and compressed her coronary artery more severely, like a tourniquet, and nearly killed her.

— K.R., M.D.

Dear K.R., M.D.: I appreciate Dr. R. writing in. I have seen myocardial bridging when I observed a cardiac catheterization as a resident, and I admit that I did not think of that possibility. But you are certainly right that this is a congenital condition.

The large coronary arteries are “epicardial,” meaning that they run on the surface of the muscle of the heart, but sometimes muscle tissue can surround the artery. This is most common in the left anterior descending artery.

As you say, if the muscle is thick enough, it can completely block blood flow through the heart while the heart is contracting. During exercise, the heart is contracting at a much greater proportion of time than it is while at rest, so it’s during exercise that myocardial bridging can cause problems. Most people with bridging never develop problems.

The diagnosis is usually made during an angiogram, but can now be made by CT scans. Treatment is with medicines, especially beta blockers, to slow the heart and reduce the amount of oxygen that the heart demands. Surgery may be necessary if medications aren’t working, which may occur in people with larger segments of bridging.

Dear Dr. Roach: I’m a 68-year-old healthy male. I tested positive for COVID a month ago. I lost my taste and have still not gotten it back after five weeks. Otherwise, I feel great and have tested negative since. When will I get my taste back? How long before I should be concerned and see my primary care physician?

— J.T.

Dear J.T.: Hopefully, by the time this letter prints, you will be on your way to recovery, although it can take a long time. Taste and smell disorders were very common with the early alpha strain of COVID and seem to be less common with the current omicron strains. However, I certainly still see patients with this issue.

My experience is that it can be just around a month when people start to get better. Studies from the early pandemic showed full recovery at four months in 84% of people, while 96% were fully recovered at eight months.

Readers may email questions to ToYourGoodHealth@med.cornell.edu.