Abstract
BACKGROUND: Acute myocardial infarction in young competitive athletes is uncommon but requires consideration of a broad underlying differential diagnosis. CASE SUMMARY: A 22-year-old male collegiate swimmer with no significant past medical or family history presented to the hospital with an ST-segment elevation myocardial infarction. After a comprehensive diagnostic evaluation, the athlete was deemed to have acute plaque rupture secondary to underlying coronary artery disease. Appropriate treatments were implemented, and return-to-play was considered. In accordance with guideline-based risk stratification and shared decision making, the athlete returned to competitive swimming. DISCUSSION: Acute myocardial infarction as a consequence of coronary artery disease is uncommon among young competitive athletes. Athletes who present with acute myocardial infarction require an understanding of potential etiologies, appropriate diagnostic evaluations, and clinical management strategies. TAKE-HOME MESSAGE: Acute coronary syndromes are rare in young competitive athletes and require a focused history and physical examination and a comprehensive diagnostic work-up.