Frequently-Asked Questions

What is a myocardial bridge (MB)?
A myocardial bridge is a section of a coronary artery that, for reasons not fully understood yet, tunnels through the heart muscle itself. (Normally, coronary arteries run along the outside the heart, not through it.) Every time the heart beats, the “bridged” section of the artery gets squashed, like a straw that you squeeze with your fingers. This cuts off blood flow to the upper left ventricle of the heart, sometimes 80% or even 100% in severe cases. The upper left ventricle is the most important ventricle because it’s where blood pumps out to the body.

Are people born with MBs?
Yes. A MB is a congenital heart defect present from birth. Stanford researchers believe MBs develop around the end of the first trimester of fetal development.

Do MBs get worse over time?
Yes, MBs definitely get worse with time for a combination of reasons:
-Endothelial dysfunction worsens the longer the artery is squashed
-Plaque continues to accumulate just before the MB
-Arteries get less pliable so reopen slower after compressed

When were MBs first discovered?
It was first mentioned by Rayman in 1737 then Black in 1805, and first described by Grainicianu in the early 1920s.

Why do many people end up going from doctor to doctor without a correct diagnosis?
Many people have gone to multiple cardiologists getting no answers, sometimes to more than ten cardiologists. Some have had ten stress tests, all showing nothing before they finally got a correct diagnosis. This is because many doctors do not know a) what the right tests are and/or b) how to perform them and/or c) how to read the tests properly specifically to diagnose MBs. This is true of all three major tests, the CT, the stress test, and the cardiac catheterization. For example, one cardiac cath may report no MB at all, and then another done right may clearly show images of an artery being compressed by 80%.

My doctor doesn’t think my MB is a big deal, he says I am fine. What should I do?
Get a new doctor and take the Stanford studies with you. Many docs give logically inconsistent diagnoses, ex. they will tell patients the MB is not a problem, yet then give them meds for it. Why would they prescribe meds if it’s not a problem?

Why do many people with MBs feel better while exercising than at rest?
It's partly because there is more to moving the blood around the body than just the heart. The middle layer (tunica media) of your arteries contains smooth muscle cells and elastic fibers which expand and contract, and they contract harder during exertion, which moves blood faster. So in other words your arteries are pumping blood too, not just the heart. Plus there is just the inertia of higher blood flow once it gets going. See images section for a diagram.

What are the “maps” Stanford makes of MBs and why are they important?
Using the results of the cardiac catheterization, Stanford produces “maps” of the MB that show precisely where it is, down to the millimeter. The maps also show its location relative to key landmarks like the junctions with septal arteries, etc. Dr. Boyd then uses these maps to make pinpointing the MB during surgery much easier, it alleviates much of the “groping” problem of having to find the MB during surgery. This is important, because many surgeons show concern about the difficulty of cutting into the heart without knowing exactly where the MB is, and some even refuse to do the surgery because of this, whereas for Dr. Boyd it seems to be a non-issue because he knows exactly where to look and cut.

Since big research hospitals do research studies using MB patient data, does that make me a guinea pig if I get surgery there? Will they try some new, untested, unproven treatment on me?
No. Getting unroofing surgery is not in any way participating in a clinical trial.Uroofing surgery has been done for 50+ years. There’s nothing new or experimental about the surgery.

Stanford does use patient data from some of the testing for their research, and depending on what research they are doing at the moment they may ask if they can do a few extra tests while you are in the cardiac cath (voluntary and optional) to help their research, but these tests do not involve taking any new drugs or doing any new procedures, they just take some extra measurements/images.

Why is Stanford so far out ahead of the pack in terms of MB research?
Stanford is one of the world’s top universities. It has a *lot* of money and technology for research. Dr. Ingela Schnittger at Stanford originally noticed that MBs could be causing symptoms in some of her patients and started the dedicated center for MB research in the 2010s.

Why is there so much misinformation and misunderstanding about MBs?
-The #1 myth about MBs, which is explained on the MB Myths page and in this video on our YouTube channel
-Up until 2020 there used to be a badly-written Wikipedia page on MBs that was spreading misinformation, including the #1 myth. We completely rewrote it, and now correct information has spread fast since then.
-Many docs were misinformed in medical school that MBs are always benign

Why do MBs tend to produce more symptoms as you get older?
1) As we get older the arteries get less pliable, so when the MB compresses it it has more difficulty bouncing back elastically
2) As we get older plaque builds up that can combine with the MB to exacerbate symptoms. In particular, research has found that plaque typically builds up just above/before MBs in the artery, but not inside the MBs. So if blood flow is already reduced by a plaque building before the MB, then it is further reduced by the MB itself, the combined reduction in flow can be very significant
3) The more of pounding the artery takes in the MB area over the years, the more endothelial dysfunction that results inside the artery, i.e. the lining of the artery no longer functions well in staying open, so it collapses.

Is the plaque before MBs dangerous?
Yes. It can eventually grow to block the artery. But also, it is common for a piece of the plaque to break off and get stuck in the MB, and cause a heart attack. Stanford says that the amount of plaque just before an MB is determined mostly by the % compression of an MB, not by the length, depth, or location. They also say the plaque just before an MB is often missed on CT scans. See this study.
Myocardial Bridge and Acute Plaque Rupture (nih.gov)

Somedays I feel ok and can live my life. Somedays I feel so bad I can't leave the house, is this normal with a myocardial bridge?"

Quote from Dr. Schnittger: "Yes, typical. MBs are dynamic blockages and can change from one moment to the next, depending on blood pressure, heart rate, adrenergic state (adrenalin) and stress hormones in the blood stream, etc. Stress hormones (e.g. cortisol) give you a tendency to more spasm, in addition to the mechanical compression of the blood vessel form the former three examples."

Is high blood pressure associated with MB?
Not necessarily. Many people with MBs have high bp, many have low bp.

Is high heart rate associated with MBs?
Same as above, not necessarily. Many people with MBs have high hr, many have low hr.

Is the length of an MB directly related to the level of symptoms?
It appears yes. Stanford has used the analogy of several lanes of traffic having to merge into a tunnel: the longer the tunnel, the more of a slowdown in traffic there will be. The tunnel is the myocardial bridge, the traffic is blood flow.

Is the depth of an MB directly related to the level of symptoms?
According to Stanford MB surgeon Dr. Boyd, not necessarily. Even a very thin band of muscle <1 mm can cause major symptoms and "wreak havoc," to quote Dr. Boyd.

Can you have MBs on multiple arteries?
Absolutely. It’s entirely possible to have an MB on the LAD and also the RCA or LCX. Some patients have had MBs on four arteries.  All of them should be unroofed not just the LAD.

Has anyone ever had 100% compression of the artery due to MB?
Yes, multiple people.

Are myocardial bridges on other arteries besides the LAD significant, like on the RCA or LCX?
Yes—despite what even Stanford says. This is just common sense, any major artery that feeds any part of your heart will have significant symptoms if it’s blocked. Several papers have been published showing major angina, collapse, and even heart attack due to MBs on the RCA and LCX.

Why do I need to use the spirometer after surgery?
During surgery, especially the thoracotomy (through the ribs), they deflate the lung and it develops fluid in the tiny openings throughout its lining. The fluid could be squeezed out by using the lungs during exercise, but after surgery you’re lying around all day. So to prevent this fluid from building up, using the spirometer frequently (every) hour helps to exercise the lungs and squeeze out the fluid.

Is fluid in the lungs after surgery a big issue?
Yes, for people who had the thoracotomy (through the ribs). Many people have to go back 1-3 weeks later to have fluid drained. This is why it is so important to use the spirometer.

Commmon Symptoms

What are the symptoms of MBs?
The combination of symptoms varies from patient to patient, since MBs come in many lengths, depths, and locations, and because their symptoms combine with other factors like endothelial dysfunction and plaque deposits. Experience seems to indicate that deeper MBs result in more chest pain specifically.

Shortness of breath (SOB)

Fatigue

Sleepiness, frequent naps

Dizziness

Squeezing/tightness/pressure/pain in chest, shoulder, arm, armpit, neck

Endothelial dysfunction (ED) – ED is a complication of MBs

Vasospasms

Inability to exercise, walk, do chores, have to sit/lie down

Chest pressure/tightness (vasospasms)

Feeling of something “clamping down” on the artery in the chest

Chest feels like “going to explode”

Fatigue when sitting down or lying down, sometimes worse than when moving and exercising

Feeling faint or actually fainting

Diagnosis (and misdiagnosis)

Why are MBs often overlooked or misdiagnosed by doctors?
Several reasons. First, doctors are typically taught that MBs are benign, so it is not something most radiologists are actively on the lookout for as they read CT scans. Even if a radiologist spots an MB, there’s a chance they may not bother to include it on their report. Because it is so rarely spotted and reported, it’s not something most doctors hear about much or know about, so it’s not something they are actively considering as they think about possible causes of your symptoms.

On top of this, even if radiologist does report an MB to your doctor, it is very likely that the doctor will not even bother to tell you because they assume it is not significant. In fact, there have been multiple cases reported on this Facebook site in which doctors/nurses did not tell the patient about an MB that was clearly written on the radiologist’s report, in one case until years later and in another never, it was only discovered by the patient reading the report directly.

Right now, there are likely thousands if not tens of thousands of MBs observed on radiologists’ reports that were never communicated to the patient, sitting in patient files around the world.

What are some common misdiagnoses that doctors have given MB patients?

“It’s all in your head"

Anxiety/stress* Note: Anxiety is both a symptom of MB and a trigger of symptoms. There’s a perennial chicken-and-egg discussion about anxiety and MBs. But people who have had unroofing say their anxiety has gone way down.

Dehydration

Mitral valve prolapse

Tachycardia

Costochondritis

Pheochromocytoma

COPD

Muscle aches

Pulled muscle

Depression

Gastrointestinal issues/acid reflux/GERD

Mononucleosis

Asthma/Exercise-induced asthma

Gall stones

Heavy metal toxicity

Lupus

Lung issues

Fibromyalgia

Misdiagnoses that are actually symptoms of MBs not causes:

Syncope

Surgical procedure options

Note: Never put a stent in a myocardial bridge. It can kill you. There are numerous reasons why:
1. Stents are compressed by the MB each heartbeat and can break, potentially causing a blockage
2. A stent sandwiches the artery between a muscle band (the MB) clamping down on it and a mesh tube (the stent) below, increasing friction on the flesh of the artery every heartbeat, wearing on the artery and increasing the chances the artery will rupture
3. Yamamoto, K, et al, 2024 shows that a stent in an MB significantly increases chances of a complete blockage of the artery aka "chronic total occlusion" or CTO
Note: Some less informed doctors have nonetheless put in stents in the past, which *cannot be removed* later because stents become part of the artery wall.

What is the best type of surgery for MBs?
The first-line treatment for MBs is unroofing surgery also known as myotomy, releasing, debridging, or deroofing. It is the only type of surgery that will fix the underlying cause of MB, by simply cutting off the band of muscle that overlays the coronary artery. It is the preferred surgery option so long as it is possible, although bypass can be added to unroofing if the artery has coronary artery disease i.e. major plaque blockages as well.

Bypass surgery or CABG (Coronary artery bypass graft) has been done for MBs with mixed results.
-Bypass surgery has several problems for MB, listed below
-However, adding bypass to unroofing i.e. both together can be a great option when there is plaque i.e. stenosis in the artery in addition to the MB.

Why is bypass surgery alone not a good idea for MBs?
1) “Competitive flow” problem: blood can continue to flow down the original artery instead of the new artery that has been grafted on.
*This Russian study by Bockeria specifically concludes that this competitive flow problem is much more likely to occur if the LIMA artery is used for the graft rather than the SVG, so the SVG is recommended.

2)  Patient is still left with an MB, which means endothelial dysfunction, vasospasms, and plaque will continue to get worse.

3) Jailed arteries are still jailed in the MB, still causing local ischemia: bypasses do not remove the MB itself, so any jailed septal arteries located inside the MB will still be compressed and not receive blood flow.

There are several ways of accessing the heart in unroofing surgery, each with advantages and disadvantages:
-Minimally-invasive thoracotomy – through the ribs
-Sternotomy – open heart surgery, cutting sternum in two
-Robotically-assisted – through small keyholes in the chest using the DaVinci machine

Unroofing surgery options

What options are there for unroofing surgery?

Three options:

Minimally-invasive thoracotomy
-Uses a 10 cm incision between the ribs
-Pain as chest pectoral muscle and incision heal, especially for those with more muscle and/or bigger incisions
-Roughly four weeks to drive and 6-8 weeks before back to work

Sternotomy
-Less pain than thoracotomy because not cutting through muscle
-For larger MBs, often preferred by surgeons compared to thoracotomy because surgeon needs high visibility

-Longest recovering time, roughly three months for sternum to heal, during which cannot use upper body for anything strenuous

Robotically-assisted
-Much shorter recovery time and less trauma to the body than other methods
-Done through small "keyholes" in the chest
-The robot is guided by the surgeon, and the robot cutting tools can cut finer than a human hand ex. peel a grape. Its can see better too, because the machine's lenses can magnify many times and go into places the physical eye cannot.

Note:
-Post-op symptoms like myocarditis, pericarditis, pleurisy, and fluid in the lung are very common on all these procedures. Fluid sometimes requires thoracentesis i.e. removing it with a needle.

Robotic surgery options

What is the difference in recovery between robotic-assisted vs. thoracotomy/sternotomy?
No comparison. Robotic has an astronomically easier and faster recovery. Hands down. Talking about a difference of a year or more and a lot of pain. Make no mistake, thoracotomy may be called "minimally-invasive" but only in comparison to sternotomy. It slices about 4 in/10 cm right through the pec muscle like a chicken breast, cutting a big muscle straight through and the recovery has more pain than sternotomy. It takes over a year to heal. Sternotomy is a bigger incision, but does not cut through muscle but bone, cutting the sternum in half. Healing time is increased if you are older.

Robotic heart surgery does not go through major muscles and does not go through bone. Robotic recovery time and pain is no comparison with thoracotomy. There are videos of people post-robotic op playing golf or tennis a week or two later.

Having said that, sometimes people have complications like lung fluid etc. from any heart surgery including robotic, which can cause lingering issues. But on the incision itself, it is no comparison.

University of Chicago – robotic-assisted unroofing surgery with Dr. Husam Balkhy
contact: Elisa email Elisa.Villalobos@uchospitals.edu

Georgia Heart Institute – Dr. Sloane Guy
https://roboticheartsurgeon.com/

How does robotic surgery work?
Robotic surgery uses tiny tools including cutting tools and a camera that enter the chest through small “keyholes” and much less invasive that the incisions made by thoracotomy or sternotomy. The surgeon manipulates the tools from a distance, sort of like a video game. There are many videos of robotic-assisted heart surgery online.

Does Stanford do robotic-assisted unroofing surgery?
At present, no Stanford does not do robotic-assisted unroofing surgery. Surgeons must train with the DaVinci machine for a long time and Dr. Boyd does not seem to have this training. He has said that the reason Stanford does not do robotic-assisted unroofing is because they don’t think there is “any difference in outcome for the patient.” However, it is obvious that this is absurd, as robotic surgery offers far shorter recovery time and much less pain than conventional surgery, and this is widely known.

Are there any robotic surgeons near me?
The number of robotic-assisted surgeons who have done unroofings is small. However, there are a few we know of:
Dr. Balkhy at U Chicago
Dr. Sloane Guy at Georgia Heart Institute
Dr. Danny Ramzy at Memorial Hermann Houston
Dr. Johannes Bonatti has also done robotic unroofing at Cleveland Clinic in Abu Dhabi, United Arab Emirates

Da Vinci Surgeon Locator site davincisurgeonlocator.com
To try to located a robotic heart surgeon, you can use the Surgeon Locator page on the Da Vinci machine website found at davincisurgeonlocator.com

Should I look for surgery with a local doctor or a research center?

Local docs can do unroofing. It has been done many times, in many states and countries, from Utah to Michigan to Puerto Rico to Pakistan to China. The issue with local docs is less about whether they can do the unroofing, it's that they sometimes (not always) will not green-light the operation, or even the right testing, because of a simple lack of knowledge about MBs, and sometimes an unwillingness to learn even the basics (like open the Wikipedia page). So people often go to Stanford because they hit a roadblock with local docs, and they know Stanford understands MBs.

Having said that, Stanford, Chicago and other major research centers generally require more testing for their research. So it can actually be a faster process if you can get it done locally, where they're not concerned with research.

Another consideration is that if you have a super-deep MB or another unusual case, Stanford or Chicago or Dr. Guy in Georgia may be the way to go, because they are world-class and can handle even cases where the MB goes through the heart wall into the chamber, they can sometimes make a little hole and patch it up. That is rarely necessary, but for that the big-time surgeons are the way to go. Of the major research centers, Stanford has now done around 300 standalone unroofing surgeries, Chicago and Cleveland Clinic have done under 30 each, and no other place has done more than a handful that we know of.

How do they actually do the unroofing surgery?

Stanford explained how they do unroofing surgery in this report:

Surgical Unroofing of Hemodynamically Significant Left Anterior Descending Myocardial Bridges
https://www.annalsthoracicsurgery.org/article/S0003-4975(16)31102-X/fulltext

Below are excerpts with translations into layman’s terms from this report, from the section "Surgical Technique”:

"The heart was positioned to expose the anterior surface of the heart, and the LAD was identified epicardially where it exited the MB distally."

They angle the front of the heart to face the surgeon, and they locate the bottom end of the MB where it comes out of the heart muscle.

"An “IVUS map” of the LAD MB (Fig 2A), created before surgery, noted relationships to diagonal and septal coronary artery branches. This was correlated to the CT images, when available, and the surgical anatomy."

Stanford makes a "map" of the MB before surgery, and they use key landmarks on that map to navigate and know where they are during surgery, like the diagonal and septal branches come off the LAD.

"A Beaver blade was used to divide the epicardium overlying the LAD where it emerged from the myocardium and epicardial fat distal to the MB."

They cut/detach the band of muscle lying on top of the LAD artery right along the bases where it connects to the rest of the heart on either side, and also cut away the surrounding fat so they can see where they are going.

"On entering the surgical plane immediately anterior to the coronary artery, tenotomy scissors were utilized to divide the overlying epicardial fat and MB, moving in a distal to proximal direction, in 1-mm to 2-mm increments until the entire bridge had been released."

One or two millimeters at a time, starting from the bottom end of the MB and working upwards, they cut away the fat and the muscle band until the entire MB is released.

"The operating surgeon and the referring cardiologist obtained visual confirmation of complete division of all myocardial fibers crossing the LAD, as well as measuring the length of the unroofed artery to compare with the IVUS map and CT images, when available."

Both the surgeon and the referring cardiologist look again to confirm that all of the muscle that was on top of the artery has been removed, and they use a surgical ruler to measure the length of the unroofed artery to compare it with they length they had estimated in the maps and images made before surgery (to make sure they did not leave any part of the MB unroofed).

Why Are Stents Never Good for MBs?

*Never let a doctor put a stent in your myocardial bridge.*
Stents *cannot be removed* once they are put in, because they meld into the artery lining. You are stuck with it.

Cleveland Clinic on why not to stent an MB:
1) Cleveland Clinic MB team leader Dr. Joanna Ghobrial made this statement:
“Surgery has already been established as superior to stenting, which carries a higher risk of perforation, stent fracture and thrombosis.” https://consultqd.clevelandclinic.org/myocardial-bridge.../

2) At 21:00 of this video, Cleveland Clinic's surgeon specifically says do not stent for multiple reasons, including breakage and the fact that it "burns bridges" as he puts it, i.e. removes options as it leaves the artery unable to be unroofed later. https://www.youtube.com/watch?v=eQ5wjM269XE

When a doctor recommends a stent for an MB, they are revealing a profound ignorance of the last 30 years of medical studies on MBs, all which say never stent an MB.

Why are stents bad for MBs? There are at least four reasons:

1) Stents can break under the pressure of the MB squeezing - or just on their own. If they do, they can block the artery and you can die.

2) Stents make it *impossible to unroof* the artery later. As Cleveland Clinic’s surgeon has said, this “burns bridges,” meaning it takes away your options for the future.

3) Stents can lead to arterial rupture. Stents put a hard surface inside the artery, which the artery becomes compressed against when the MB squeezes down on it. The MB artery wall is thus sandwiched in between the MB band of muscle and the stent every time the MB squeezes on the artery each heartbeat, pressing into something hard. This has the potential to wear away on the artery wall, damaging it and potentially causing the artery itself to rupture, which could be fatal. A ruptured artery is already one of the possible outcomes of an MB even without a stent, and a stent only increases the chances.

4) A stent can lead to a kink i.e. sharp turn in the artery at the end of the stent, which leads to less flow through the kink and also could lead to a rupture in the artery. Such a kink developed from a stent with someone on our site.

Our FAQ doc has about 50 studies listed, all contraindicate stents. Stanford, the leader in MB research, has published over 15+ papers on MBs just in the last 7 years, all say never stent an MB.

Why would a "prestigious" doc recommend a stent? Medicine is highly specialized. A doc can be an expert in one area of cardiology and completely ignorant in another. Cardiologists new to MBs often think their usual heart treatments will work: stents, bypasses, meds, etc. They don't work. The docs don't always do their homework on a new condition. Conversely, many local docs with less prestige have been more willing to learn, did their homework, and helped patients successfully get unroofing surgery.

Health insurance

What insurance companies have covered testing and unroofing?

*Every state and policy is different – make sure to check your specific policy before scheduling surgery
Blue Cross Blue Shield PPO and HMO - New York, Alabama, Massachusetts, South Carolina, Florida, California
Anthem
Cigna
Regents (Washington State)
Aetna PPO
United Health Care PPO
Humana Medicare
Medicare
Quartz Wisconsin
WellCare Kentucky
Harvard Pilgrim
MVP

Is unroofing surgery covered by most US health insurance companies?
It’s covered by many but you have to check. Stanford and other hospitals will usually check for you, and Stanford will lobby for coverage if it is denied at first.

How can I afford to pay a high health insurance premium to make sure unroofing surgery is covered?
In the US, you can cancel your health insurance at any time. So one strategy people have done is to get high-end insurance starting in January, have the operation early in the year, and then cancel it and switch to a cheaper insurance.

Is unroofing surgery covered by health insurance in most countries?
Some yes, some no. For example, people in the UK, Ireland, Australia, Italy, Singapore and other countries on this FB site are not covered for surgery. On the other hand, certain countries like Belgium and UAE seem to cover it, surgeries have been done there. We have yet to find a common reason why some countries cover it and some do not.

What are the MB symptoms and triggers reported by FB site members?

Any type of stress or excitement good/bad

Elevated heart rate

Hot and humid weather – summer is bad for people with MBs, because  hot humid air has less oxygen per liter in it. Also this site says humidity causes lungs to tighten their airways, making it harder to breathe.

Cold temperatures

Exercise (some feel better with exercise, some worse)

Sitting/doing nothing for long periods

Lying flat on the back or in a recliner

Weather change

Big meals

Spicy foods

Flying in an airplane (although almost everyone on our site reports that they can fly safely)

High altitude

Dehydration

General fatigue

Standing up for longer periods

Caffeine

Alcohol

Cold, flu, fever

PMS/hormonal changes

Menopause

Going up stairs

Intense activity like driving or riding a motorcycle

Cleaning, vacuuming

Extreme bass sounds or thumping

What other conditions are often found along with MBs?

Plaque just above/before the MB – due to backwash of blood that is blocked by MB
(Stanford says every case they have seen has plaque in this location)

Endothelial dysfunction (ED) which can cause vasospasms - this is a direct result of the MB physically squashing the artery for years

Microvascular disease (MVD)

Hypertrophic cardiomyopathy (thickened heart muscle)

Anomalous coronary artery (AAOCA) – study shows 6% of patients with MB also have AAOCA

Narrowed artery (artery itself is thinner in diameter even without plaque)

Tortuous/corkscrew pattern to the artery – means the artery has tightly twisting pattern

Kink in the artery i.e. a hard bend that can reduce flow

Prinzmetal’s angina

Do I need a new doctor?

You need a new doctor if…

-They believe that MBs cannot cause symptoms

-They believe Myth #1, that MBs do not affect diastole (the diastolic period i.e. when the heart is relaxed, not contracting).

-Your doctor doesn’t think that unroofing “works.”  This is often because they "heard patients still have symptoms after unroofing," which is Myth #2.

-You doctor believes Myth # 3, that your MB is too short or too shallow to cause symptoms.

-Your doctor believes Myth #4, that because you exercise (and possibly feel better with exercise), it is not possible that your MB  is causing you symptoms.

-Your doctor thinks unroofing is a new and/or risky surgery. Unroofing has been around for 50+ years. See reports of unroofing going back decades in the Medical Literature page.

-Your doctor can’t point to a scan and show you exactly where your MB and show the approximate length. Many top doctors and surgeons cannot.

-Your doctor says your MB is no big deal… and worse, then prescribes you meds for it.

-Your doctor refuses to read any of the vast medical literature on MBs and yet makes definitive conclusions about your case

-Your doctor keeps prescribing more and more meds, more halter monitor tests, more stress echo tests after you have done them already, yet does not consider unroofing an option.

-Based on just a stress echo and/or EKG, your doctor rules out the possibility that the MB is causing symptoms. These are not the key tests for MBs, neither test can actually see the MB. CT and cath are the key tests, stress echo is only a test to support that there is ischemia but only if they know how to read it for MBs, which many do not). EKG is almost irrelevant, people often have a normal EKG and an MB.

-Your doctor thinks that endothelial dysfunction (ED) and vasospasms can improve without unroofing

-Your doctor does not recognize that endothelial dysfunction (ED) and vasospasms in the MB area are caused by the MB

-Your doctor thinks a bypass alone is the best treatment for MBs (bypasses can be a good idea along with unroofing in some cases, but unroofing is the first-line treatment without question)

-Your doctor thinks a stent is a good treatment for MBs. *Never* put a stent in an MB - it could kill you later. See why in the FAQ.

-Your doctor dismisses the medical literature from research institutions like Stanford (ex. they are “just looking to make money” or “just looking for patients for their studies”)

-Your doctor refuses to do an IVUS cath measuring DFFR or iFR, and using dobutamine, instead doing FFR or some other type of cath which is “useless” in diagnosing MBs according to Dr. Schnittger at Stanford