Naqvi Syed M, Nadeem Amin Ur Rehman
Pulmonary Disease, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, USA.
Critical Care, Captain James A. Lovell Federal Health Care Center, Rosalind Franklin University of Medicine and Science, North Chicago, USA.
Cureus. 2024 Dec 25;16(12):e76388. doi: 10.7759/cureus.76388. eCollection 2024 Dec.
This is a case of a young, 20-year-old, male Navy recruit who was admitted to our healthcare facility with intermittent atypical chest pain and limiting exertional symptoms and was diagnosed with myocardial bridging (MB) as the most likely etiology of his chest after the complete cardiac workup, leading to his career limitations due to potential risks. Our patient presented with atypical chest pain and limiting exertional symptoms. Chest pain was non-radiating. His family history was positive for myocardial infarction on his mother's side under the age of 40 but negative for tobacco use, family history of other cardiac anomalies, or recent illness. Vitals and initial labs were within normal limits. Chest X-ray showed no acute findings. The electrocardiogram (ECG) was noted for early repolarization and biphasic T waves in leads V2 and V3. Acute coronary syndrome (ACS) was ruled out. His transthoracic echocardiography (TTE) was normal. The cardiac stress test was negative for any reversible ischemic changes. The coronary computed tomography angiogram (CCTA) confirmed the diagnosis of symptomatic MB. The patient was started on metoprolol, and his chest pain improved. His follow-up ECG showed a resolution of T-wave changes. Based on further recommendations from cardiology, the patient had undergone entry-level separation from the Navy because of symptomatic MB. Our case emphasizes the need for awareness of this rare cause of non-atherosclerotic coronary ischemia in young patients presenting with chest pain who do not fit the picture of atherosclerotic heart disease. Therefore, timely recognition of MB in these young patients by the healthcare provider by ruling out ACS and earlier risk assessment by performing transthoracic TTE and CCTA, if indicated, is crucial and can prevent any significant events by prompt intervention and management.
这是一例20岁年轻男性海军新兵的病例，他因间歇性非典型胸痛和运动受限症状入住我们的医疗机构。在完成全面的心脏检查后，被诊断为心肌桥（MB），这是其胸痛最可能的病因，由于存在潜在风险，导致其职业受限。我们的患者表现为非典型胸痛和运动受限症状。胸痛无放射痛。他的家族史显示，其母亲一方有40岁以下心肌梗死的阳性家族史，但无吸烟史、其他心脏异常家族史或近期疾病史。生命体征和初始实验室检查结果均在正常范围内。胸部X线检查未发现急性病变。心电图（ECG）显示V2和V3导联早期复极和T波双向。排除了急性冠状动脉综合征（ACS）。他的经胸超声心动图（TTE）正常。心脏负荷试验未发现任何可逆性缺血改变。冠状动脉计算机断层扫描血管造影（CCTA）证实了有症状性MB的诊断。患者开始服用美托洛尔，胸痛症状改善。他的随访心电图显示T波改变消失。根据心脏病学的进一步建议，该患者因有症状性MB已从海军初级退役。我们的病例强调，对于表现出胸痛但不符合动脉粥样硬化性心脏病特征的年轻患者，需要认识到这种非动脉粥样硬化性冠状动脉缺血的罕见病因。因此，医疗保健提供者通过排除ACS及时识别这些年轻患者中的MB，并在必要时通过进行经胸TTE和CCTA进行早期风险评估至关重要，通过及时干预和管理可以预防任何重大事件。
