Case of a Young Male Recruit With Chest Pain Leading to Entry-Level Separation and Career Termination

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.