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A heart disease for a person below the age of 20 years was unheard of, unexpected or even suspected by doctors. Recently, a 19-year-old boy presented to SSB Hospital with a history of chest pain radiating to the jaw and left shoulder for 4 hours along with vomiting. On investigation, it was found that he was suffering a heart attack called anterior wall myocardial infarction which occurs due to blockage of a very important artery of the heart called LAD. His heart pumping capacity (ejection fraction) also went down to 40% due to the heart attack.
After initial investigations, he was taken for angiography which showed critical 99% blockage in LAD with a large blood clot called thrombus. After aspiration of thrombus with an aspiration catheter called Hunter, emergency angioplasty and stenting was done to open the blocked LAD. Post the procedure, the patient started recovering from the heart attack very fast.
In this case, the risk factors responsible for the heart attack were history of smoking, family history of heart disease (father had heart disease) and high level of Homocysteine called hyperhomocysteinemia. He didn’t have usual risk factors like diabetes, high cholesterol and high BP. However, unusual risk factors like homocysteine and hs CRP were very high.
High levels of homocysteine are linked to early development of heart disease.
If the homocysteine level is too high, it can lead to clot formation, thereby causing heart attack. These patients are managed with high doses of Vitamin B12, folic acid and blood thinners. This case highlights the importance of serum homocysteine level and hs-CRP . High hs-CRP is managed with statins. This case also emphasises that young age should not be a criteria for ruling out heart attack without investigations.
Our team made a timely diagnosis. I performed his life-saving angioplasty and stenting immediately within 4 hours of heart attack. Timely diagnosis and angioplasty is the key to success in such patients. As many as 33% of such patients can die within 24 hours if timely active treatment like angioplasty or thrombolysis is not done. Those who survive without active treatment are left with a very damaged and weak heart just after 24 hours, with future risk of heart failure. Therefore, if there is a family history of hyperhomocysteinemia and heart disease, all first degree relatives must get their serum homocysteine and hs-CRP levels checked.