Background: Coronary artery disease (CAD) is a predominant cause of mortality worldwide and can present with a range of symptoms that may obscure diagnosis, particularly in younger patients. The variability in symptom presentation, coupled with the potential for misinterpretation of diagnostic tests, often leads to delays in appropriate treatment, thereby increasing the likelihood of adverse outcomes. This case report seeks to elucidate the complexities in diagnosing and managing CAD, especially in younger patients with atypical symptoms, by detailing the clinical experience of a 38-year-old patient diagnosed with CAD.

Case Illustration: A 38-year-old patient presented with chest pain and was evaluated at two separate hospitals. At the first hospital, initial diagnostic tests included an exercise stress electrocardiogram (ECG) and an echocardiogram. The stress ECG results indicated inducible ischemia, although the echocardiogram appeared normal. When the patient experienced recurrent chest pain, they sought further evaluation at a second hospital. There, an ECG detected ischemic changes, and subsequent blood tests corroborated the CAD diagnosis. After the patient's condition was stabilized, a coronary angiography (CAG) was performed, revealing a mild lesion in the left anterior descending (LAD) artery along with a myocardial bridge. The patient was managed with a combination of medications, including beta-blockers and antiplatelet therapy. However, due to persistent symptoms, the patient was ultimately advised to undergo coronary artery bypass surgery.

Conclusion: This case highlights the diagnostic challenges inherent in managing CAD, particularly among younger patients who present with atypical symptoms. The inconsistency between non-invasive test outcomes and the fluctuating nature of CAD symptoms underscores the importance of thorough and continuous clinical evaluations. Recognizing these complexities is crucial for enhancing patient outcomes and informing clinical decision-making in similar scenarios.