A rare cause of early repolarisation in an adolescent boy with chest pain: myocardial bridging

Early repolarisation is a common electrocardiographic (ECG) finding characterised by J-point and ST segment elevation ≥ 0.1 mV in two or more adjacent leads. The ECG pattern of early repolarisation is relatively common in asymptomatic subjects. Early repolarisation pattern may be seen in secondary conditions such as hypothermia, autonomic nervous system disturbances, cocaine abuse, hypercalcaemia and myocardial ischaemia. We present a case of an adolescent boy with chest pain and concurrent ST-segment elevation. Early repolarisation pattern was observed in the inferior leads of the ECG with increased troponin levels. He was shown to have myocardial bridging of the left anterior descending artery. The coronary anomaly was not associated with left ventricular hypertrophy. He was asymptomatic and the ECG changes normalised on the third day after admission. The patient was restricted from strenuous exertion and metoprolol was prescribed for prophylaxis.