A rare manifestation of a common problem: resting ST-segment depression on the exercise treadmill test: Case report

Myocardial bridge (MB), where a coronary artery segment is overlaid by myocardium, is often asymptomatic but can lead to serious complications. This case highlights a rare electrocardiographic manifestation of MB: resting ST-segment depression when transitioning from a supine to a standing position.

A 39-year-old male with no significant medical history presented with intermittent, nonexertional chest pain. His resting electrocardiogram was normal in the supine position but showed ST-segment depression in leads II, III, aVF, and V5-V6 when standing.

Coronary angiography confirmed a MB in the left anterior descending artery.

The patient was managed with beta-blockers, aspirin, and rosuvastatin therapy.

After 8 months of follow-up, no complications or cardiac symptoms were observed.

This case underscores the importance of recognizing positional ST-segment changes as a potential indicator of MB, offering valuable insights into the diagnosis and management of this condition.