Musculoskeletal Chest Pain with Concurrent Viral Hepatitis: This is a common cause of chest pain in young adults, often related to muscle strain or costochondritis, combined with elevated liver enzymes suggesting a viral hepatitis (e.g., hepatitis A, B, or C) which could explain the AST, ALT, and bilirubin levels.

Myocarditis: Inflammation of the heart muscle, which can cause chest pain and elevated liver enzymes due to the systemic nature of the inflammation.
Pericarditis: Inflammation of the pericardium, the sac surrounding the heart, can cause chest pain and may be associated with mild elevations in liver enzymes.
Viral Hepatitis with Chest Pain: Certain viral hepatitis infections can cause systemic symptoms including chest pain, alongside the liver enzyme elevations.

Acute Coronary Syndrome (ACS): Although less common in young adults, ACS (including myocardial infarction) must be considered, especially if there are risk factors or symptoms suggestive of cardiac ischemia.
Pulmonary Embolism (PE): Can cause chest pain and, although less directly related to liver enzyme elevation, is a critical diagnosis not to miss due to its high mortality rate if untreated.
Aortic Dissection: A life-threatening condition that can cause chest pain and may have associated liver enzyme elevations due to the systemic inflammatory response.

Alpha-1 Antitrypsin Deficiency: A genetic disorder that can cause liver disease and might present with chest pain if there are associated pulmonary symptoms.
Wilson's Disease: A rare genetic disorder leading to copper accumulation in the liver and other organs, potentially causing liver enzyme elevations and could have systemic symptoms including chest pain.
Autoimmune Hepatitis: Although rare, it can cause significant liver enzyme elevations and might be associated with systemic symptoms including chest pain due to the autoimmune nature of the disease.