Aeromedical Implications of Myocardial Bridging in Flight Crew: A Retrospective Analysis

Abstract

Aims: This   study examines the epidemiological characteristics and analyzes the modes of discovery and positive diagnosis of myocardial bridge (MB) in aircrew, as well as the fitness-related decisions. Study Design: The study is carried out at the Aeromedical Expertise Center at the Mohammed V Military Teaching Hospital in Rabat, Morocco, between June 2023 and May 2025. Methodology: The study population consisted of all flight members with a confirmed MB who underwent examinations during this timeframe. We collected administrative data, medical data, and the final fitness decision. Results: For a total of 10,915 aeromedical examinations we identified 5 cases of MB, showing a prevalence of 0.45 per 1,000 among flight personnel. The cohort, with a mean age of 42 (range 24-55), comprised four males and one female, including three pilots and two cabin crew members. The MBs were all discovered incidentally during routine assessments. Four subjects had abnormal resting ECGs and all showed electrically positive exercise stress tests. Coronary CT angiography confirmed MB in all cases, predominantly in the mid- and distal left anterior descending artery segments. For the medical outcomes, 40% of the assessed aircrews were deemed fit for duty without restrictions, 40% were declared fit with a restriction of regular cardiological surveillance, and 20% was declared medically unfit due to a long and compressive MB with a significant hemodynamic impact. Conclusion: In the specific context of aviation medicine, MB takes on particular significance. The unique stresses of the flight environment can either reveal or exacerbate a latent myocardial bridge. The epidemiological characteristics, location, and management of myocardial bridge do not differ between the general population and flight crew and the aeromedical fitness depends on several conditions and the decision is made on a case-by-case basis.