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

RATIONALE: 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.

PATIENT CONCERNS: 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.

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

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

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

LESSONS: 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.