Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-23T09:02:56.711Z Has data issue: false hasContentIssue false
  • English
  • Français

A 16-year-old with ST elevation myocardial infarction: case report and review of the literature

Published online by Cambridge University Press:  02 October 2015

Dustin Hill ,
Adam Waldman  and
Deepak Vivek
Dustin Hill*
Affiliation:
Orlando Health, Department of Internal MedicineOrlando, Florida, United States of America
Adam Waldman
Affiliation:
Orlando Heart Center, Orlando, Florida, United States of America
Deepak Vivek
Affiliation:
Orlando Heart Center, Orlando, Florida, United States of America
*
*Correspondence to: D. Hill, Orlando Health, 21 W. Columbia Street, Suite 102, Orlando, FL 32806, United States of America. Tel: +813 340 3343; Fax: +(321) 841 5101. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Chest pain in young adults presents a unique diagnostic challenge, placing young patients at an increased risk to be misdiagnosed, as this patient population typically does not demonstrate the traditional risk factors associated with cardiovascular disease. This study details the case of a 16-year-old male who presented with new-onset chest pain and ST elevation on electrocardiogram. His history was unremarkable for known cardiac risk factors, but laboratory evaluation demonstrated markedly elevated troponins and electrocardiographic findings confirmed ST-segment elevation myocardial infarction. Coronary angiography demonstrated 100% occlusion of the left anterior descending artery, which was managed with percutaneous transluminal coronary angioplasty, thrombectomy, and bare-metal stenting. The patient had an uneventful recovery. This study examines the major causes of ST elevation myocardial infarction in young adults and reviews the major differences between younger and older myocardial infarction populations with emphasis on risk factor profile, pathophysiological mechanisms, clinical presentation, angiographic findings, and prognosis. This review highlights the need for consideration of a wide differential in younger subsets of the population presenting with chest pain and ST elevation. The implementation of current adult management protocols and guidelines for ST elevation myocardial infarction should not be overlooked due to age. Given the potential for premature death and long-term disability with resulting individual and societal consequences, it is crucial to understand the importance of correct diagnostic evaluation in this clinical scenario.

Keywords

ST-segment elevation myocardial infarction in the youngcardiovascular diseaseheart diseasepremature coronary artery diseasechest pain in the young
Type
Review Articles
Information
Cardiology in the Young , Volume 26 , Issue 2 , February 2016 , pp. 230 - 236
Copyright
© Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Osula, S, Bell, GM, Hornung, RS. Acute myocardial infarction in young adults: causes and management. Postgrad Med J 2002; 78: 27–30.CrossRefGoogle ScholarPubMed
2. Tuzcu, EM, Samir, RK, Eralp, T, et al. High prevalence of coronary atherosclerosis in asymptomatic teenagers and young adults evidence from intravascular ultrasound. Circulation 2001; 103: 2705–2710.CrossRefGoogle Scholar
3. McGill, HC, McMahan, CA, Zieske, AW, et al. Association of coronary heart disease risk factors with microscopic qualities of coronary atherosclerosis in youth. Circulation 2000; 102: 374–379.Google Scholar
4. Strong, JP, Malcom, GT, McMahan, CA, et al. Prevalence and extent of atherosclerosis in adolescents and young adults: implications for prevention from the Pathobiological Determinants of Atherosclerosis in Youth Study. JAMA 1999; 281: 727–735.CrossRefGoogle Scholar
5. Bajaj, S, Shamoon, F, Gupta, N, et al. Acute ST-segment elevation myocardial infarction in young adults: who is at risk? Coron Artery Dis 2011; 22: 238–244.CrossRefGoogle ScholarPubMed
6. Zimmerman, F, Cameron, A, Fisher, L, et al. Myocardial infarction in young adults: angiographic characterization, risk factors, and prognosis (Coronary Artery Surgery Study Registry). J Am Coll Cardiol 1995; 26: 654–661.CrossRefGoogle ScholarPubMed
7. Jalowiec, DA, Hill, JA. Myocardial infarction in the young and in women. Cardiovasc Clin 1988; 20: 197–206.Google Scholar
8. Vivo, R, Krim, S. ST elevation myocardial infarction in a teenager: case report and review of the literature. South Med J 2009; 102: 523–526.Google Scholar
9. Goldberg, RJ, McCormick, D, Gurwitz, JH, et al. Age-related trends in short-and long-term survival after acute myocardial infarction: a 20-year population-based perspective (1975–1995). Am J Cardiol 1998; 82: 1311–1317.CrossRefGoogle ScholarPubMed
10. Yunyun, W, Tong, L, Yingwu, L, et al. Analysis of risk factors of ST-segment elevation myocardial infarction in young patients. BMC Cardiovasc Disord 2014; 14: 179.Google Scholar
11. Fournier, JA, Cabezón, S, Cayuela, A, et al. Long-term prognosis of patients having acute myocardial infarction when ≤40 years of age. Am J Cardiol 2004; 94: 989–992.CrossRefGoogle Scholar
12. John, J, Wolfenstetter, SB, Wenig, CM. An economic perspective on childhood obesity: recent findings on cost of illness and cost effectiveness of interventions. Nutrition 2012; 28: 829–839.CrossRefGoogle ScholarPubMed
13. Hubert, HB, Feinleib, M, McNamara, PM, Casteli, WP. Obesity as an independent risk factor for cardiovascular disease: a 26 year old follow-up of participants in the Framingham Heart Study. Circulation 1983; 67: 968–973.CrossRefGoogle Scholar
14. Farmer, J, Gotto, AM Jr. Dyslipidemia and other risk factors for coronary artery disease. In: Braumwald E ed Heart Disease: A Textbook of Cardiovascular Medicine. Saunders, Philadelphia, 1997: 1126–1160.Google Scholar
15. Cremer, P, Nagel, D, Mann, H, et al. Ten year follow-up results from the Goettingen Risk, Incidence and Prevalence Study (GRIPS). I. Risk factors for myocardial infarction in a cohort of 5790 men. Atherosclerosis 1997; 129: 221–230.Google Scholar
16. Taylor, F, Huffman, MD, Macedo, AF, et al. Statins for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev 2013; 1: CD004816.Google Scholar
17. Warren, SE, Thompson, SI, Vieweg, WVR. Historic and angiographic features of adults surviving myocardial infarction. Chest 1979; 75: 667–670.Google Scholar
18. DeFaire, U, Friberg, L, Lundman, T. Concordance for mortality with special reference to ischemic heart disease and cerebrovascular disease. A study on the Swedish twin registry. Prev Med 1975; 4: 509–517.CrossRefGoogle Scholar
19. El Menyar, AA. Drug-induced myocardial infarction secondary to coronary artery spasm in teenagers and young adults. J Postgrad Med 2006; 52: 51–56.Google Scholar
20. Williams, MJ, Restieaux, NJ, Low, CJ. Myocardial infarction in young people with normal coronary arteries. Heart 1998; 79: 191–194.Google Scholar
21. Quereshi, AI, Suri, MFK, Gutermann, LR, Hopkins, LN. Cocaine use and the likelihood of non fatal myocardial infarction and stroke; data from the third national health and nutrition examination survey. Circulation 2001; 103: 502–506.Google Scholar
22. Amin, M, Gobelman, G, Buttrick, P. Cocaine induced myocardial infarction: a growing threat to men in their 30’s. Postgrad Med 1991; 90: 50–55.Google Scholar
23. Stankowski, RV, Kloner, RA, Rezkalla, SH. Cardiovascular consequences of cocaine use. Trends Cardiovasc Med 2014; 25: 517–526.Google Scholar
24. Choudhury, L, Marsh, JD. Myocardial infarction in young patients. Am J Med 1999; 107: 254–261.CrossRefGoogle ScholarPubMed
25. Manzi, S, Meilahn, EN, Rairie, JE, et al. Age-specific incidence rates of myocardial infarction and angina in women with systemic lupus erythematosus: comparison with the Framingham Study. Am J Epidemiol 1997; 145: 408–415.CrossRefGoogle ScholarPubMed
26. Maor, E, Fefer, P, Varon, D, et al. Thrombophilic state in young patients with acute myocardial infarction. J Thromb Thrombolysis 2015; 39: 474–480.CrossRefGoogle Scholar
27. Timmer, JR, Hoekstra, M, Nijsten, NW, et al. Prognostic value of admission glycosylated hemoglobin and glucose in nondiabetic patients with ST-segment-elevation myocardial infarction treated with percutaneous coronary intervention. Circulation 2011; 124: 704–711.Google Scholar
28. Kofflard, M, de Jaegere, P, van Domburg, R, et al. Immediate and long-term clinical outcome of coronary angioplasty in patients aged 35 years or less. Br Heart J 1995; 73: 82–86.CrossRefGoogle ScholarPubMed
29. Sturzenhofecker, P, Samek, L, Droste, C, et al. Prognosis of coronary heart disease and progression of coronary atherosclerosis in post infarction patients under the age of 40. In Roskamm, H (ed) Myocardial Infarction at Young Age. Springer-Verlag, Heidelberg, 1981: 82–91.CrossRefGoogle Scholar
30. Hong, MK, Cho, SY, Hong, BK, et al. Acute myocardial infarction in young adults. Yonsei Med J 1994; 35: 184–189.Google Scholar
31. Doughty, M, Mehta, R, Bruckman, D, et al. Acute myocardial infarction in the young—the University of Michigan experience. Am Heart J 2002; 143: 56–62.Google Scholar
32. Rathod, KS, Jones, DA, Gallagher, S, et al. Atypical risk factor profile and excellent long-term outcomes of young patients treated with primary percutaneous coronary intervention for ST-elevation myocardial infarction. Eur Heart J Acute Cardiovasc Care 2015; Jan 14: pii: 2048872614567453.Google Scholar
33. Patrizi, R, Pasceri, V, Sciahbasi, A, Summaria, F, Rosano, GM, Lioy, E. Evidence of cocaine-related coronary atherosclerosis in young patients with myocardial infarction. J Am Coll Cardiol 2006; 47: 2120–2122.CrossRefGoogle ScholarPubMed
34. Klein, LW, Agarwal, JB, Herlich, MB, et al. Prognosis of symptomatic coronary artery disease in young adults aged 40 years or less. Am J Cardiol 1987; 60: 1269–1272.Google Scholar