Myocardial Bridging as a Typical Cause of Chest Pain in a Psychiatric Patient: A Case Report.

Chest pain is a frequent cause of emergency medical visits and can result from either benign or life-threatening conditions. While atherosclerotic coronary artery disease is the most common etiology, other causes of myocardial ischemia, such as congenital anomalies like myocardial bridging, should also be considered. This case report is about a 45-year-old male with a psychiatric history of major depressive disorder and generalized anxiety, under treatment with fluvoxamine. He had multiple visits over six years to primary care for chest pain episodes consistently attributed to anxiety, with normal ECG findings. In 2024, he presented with worsening chest pain at rest, fatigue, and exertional dyspnea. While initial assessment in the emergency department was unremarkable, further evaluation showed ischemia on stress testing and hypokinesis on echocardiogram. Coronary angiography revealed a myocardial bridge in the left anterior descending artery with no obstructive lesions. He was discharged on beta-blockers and referred for outpatient cardiology follow-up. This case highlights the diagnostic challenge of chest pain in the presence of psychiatric comorbidities. It underlines the importance of comprehensive evaluation and consideration of less common causes of ischemia, such as myocardial bridging, especially when symptoms persist despite reassuring initial tests. Myocardial bridging, although frequently asymptomatic, may present with angina-like symptoms and should be part of the differential diagnosis for non-obstructive ischemia. A careful and holistic clinical approach is essential to avoid diagnostic delays, particularly in patients with overlapping psychiatric symptoms. Furthermore, this case aims to raise awareness among physicians about less common causes of chest pain.