Youngest MI you've seen

[Interpolfanclub]

30 yo HTN, morbid obesity, smoker 1 hr substernal CP radiates to L arm gone with nitro eating, talking on cell phone rest of shift.

1st trop 0.01
2nd 0.026

Negative adenosine nuc then 3rd trop 0.057.

Anybody seen MIs in their 20s?

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[littlefield]

The numbers you report don't constitute ACS where I work, but I don't know your trop value ranges.

My case: 31 y/o F, no risk factors, chest pain, atypical, associated with stress, tearful. Seen the night before at another ED, had a normal EKG and negative trop X 1, discharged with anxiety and Ativan. I was about to do the same when I was handed the EKG: Wellen's morphology. Added enzymes, initial Trop 1.5, cath revealed 100% proximal LAD lesion.

 

[NateintheED]

20 y/o male. Thin, otherwise healthy to anyone's knowledge. Presented c/o intermittent CP that was doing OK at time of presentation. While in ED, had increase in pain with dynamic ST changes. Positive trop (don't remember the number). Went to cath, had large thrombosed coronary artery aneurysm that they couldn't get past in cath lab, so went for emergent CABG. Our working theory is that he probably had Kawasaki's as a kid.

Also, one of my peds EM attendings the other day saw a kid <1 y/o with c/o wheezing. Got a CxR that had cardiomegaly. Trop positive (also don't remember the number). Aberrant coronary artery on cards workup. Last I checked, was on ECMO in the PICU.

 

[Apollyon]

27 y/o Bangladeshi male. In Queens, the CAD in the Bangladeshi males seemed to be an independent risk factor.

 

[southerndoc]

Troponin >0.49 constitutes NSTEMI in my hospital. However, I've seen troponins of 5 without NSTEMI (caused by myocarditis, traumatic injury, etc.).

 

[Jwax]

My husband at the age of 30. Not thin, but certainly not fat... just has a bit of extra pudge. 18 pack year smoking history, very elevated cholesterol and triglyceride levels due to many years of a fast food diet (even though his body type didn't show it). I don't know the details of any labs b/c I was a lowly pre-med at the time, but he got two stents at the cath lab. 2 years later he got a 5-vessel CABG after presenting w/unstable angina and cath lab finding >90% occlusion of the stents. No family history of stroke/MI/HTN, no history of Kawasaki's or any heart problems as a kid. Poor diet + smoking + the short straw = fun times.

 

[DrMom]

19 year old female, hx DM. CC: neck pain. Completely denied CP(but for some reason the triage nurse had written CP down which is the only reason an EKG was done). STEMI on EKG. Got a stent in the cath lab.

Makes me want to vomit every time I think about this patient.

 

[CraftyMed]

A (nurse) co-worker's husband: 32 yrs old, had an MI, got 3 vessel CABG. triglycerides were 800's. the TGs are down to 300's now, scary, but an improvement!

 

[Arcan57]

16 yo female with CP, anterior STEMI on EKG. We had to transfer her across the street to the adult hospital for the cath. Ended up being an aberrant left coronary artery.

Had a 23 yr old female with pleuritic chest pain, no personal or family hx of CAD, HTN, HLD, or DM. No hx of cocaine or sympathomimetic use either. First POC troponin was 0.81. She was still waiting to go to the CT scanner when her 90 minute trop came back at 3.04. Interventionalist took her to the cath lab, found triple vessel disease. When he called me back with the results he was bemoaning trying to convince the CT surgeons to CABG a 23yo.

 

[J-Rad]

Sometime in the year prior to starting my peds residency there was a newborn in the hospital who infarcted due to polycythemia.

 

[Greenbbs]

on lifeflight last night:

28 year old IWMI, 4mm elevations in the leads. Troponin of 13.91

no risks, no drug use (confirmed by tox). had been having intermittent symptoms for about a day.

scared the shizzle outta me cuz that kid was younger than i am by 2 years.

 

[SoCuteMD]

What's "IWMI" - I know WM is "white male"

 

[crewmaster1]

Inferior Wall MI

 

[crewmaster1]

Inferior Wall MI

 

[roja]

22. ran marathons, etc in the military. no drugs. LDL of 13

 

[deleted65604]

Very disturbing post. Youngest I've seen was 27, who smoked.

Completely the end of the spectrum, I took care of a 70 yo female who had no complaints, however, if you grilled her extensively, on ROS, she was feeling fatigued on occasion. Office docs got an EKG, which showed she had a STEMI- they booted her out in a heart beat. So, there she was in the ER, no pain, no current fatigue, no nothing, with a beautiful anterior STEMI, She was cathed and got some stents.

I knew a guy in college who was 24, and kept having "indigestion". It became rather severe one day, so his wife decided to drive him to the ER. He arrested on the way, and they couldn't revive him. Wife widowed at 22 years old. He came from one of those families with ridiculously high cholesterol, and heart attacks in their 30's, but for some reason, his parents had never told him to get his checked.

 

[kungfufishing]

Any of these actually myocarditis?

 

[deleted6669]

23 yrs old. Smoked meth.
Inferior wall.

seen by my dad( a doc):
21 yr old. fatal MI. total cholesterol>800.

 

[dchristismi]

28 yo M, smoker, type I diabetic, atypical CP but not getting better, nl EKG, someone called cards on a whim, something made them decide to cath him, and he had a 5v CABG the next day for his >90% multivessel stenosis. (I took care of him in the ICU.)

He at least had risk factors.

A colleague had a 32 yo F, smoker but no other history, neg w/u in ED, but he was concerned. Called the primary who belittled him for wanting to admit this "bronchitis" and proceeded to send her home. Came back 2 weeks later with a trop of 10.

Younger and younger - we'll be seeing teenagers with STEMIs at this rate.

 

[Stitch]

16 yo female with CP, anterior STEMI on EKG. We had to transfer her across the street to the adult hospital for the cath. Ended up being an aberrant left coronary artery.

I had a similar story in a 12 year old. He actually went to an adult ER and was transferred to us after EKG was abnormal and cardiac enzymes were elevated. Honestly if he had come to us at the peds hospital first, we probably would not have caught it as quickly.

 

[Khaos]

6 yo progeria patient. She had a previous MI at the age of 5 yo.

 

[MGG1848]

22 or 23 y/o with atypical "BS" cp. elevated enzymes. Goes to cath, vfib arrest on the table, multivessel disease, CABG. Survives and does well.

 

[Arcan57]

The big question is: has seeing these young & "no/low-risk" patients with MIs changed your work-up?

 

[Jeff698]

The big question is: has seeing these young & "no/low-risk" patients with MIs changed your work-up?

It has decreased my threshold for getting an ECG (which was pretty low to begin with) but not markers.

Take care,
Jeff

 

[Arcan57]

I always get CXR, EKG as part of (and usually entire) young chest pain work-up. The 23yo with triple vessel disease had serial normal (not even non-specific T-waves) EKGs in the department.

 

[CommunityED]

27 y/o dental student dropped dead at the gym. Autopsy found 100% proximal LAD, just off the take off of the left main

 

[deleted65604]

I think the most disturbing young MI I have ever had was a schizophrenic guy who was 38. I know, not so young. He had no risk factors. He didn't smoke, no family history, no diabetes. He always came into the ER for wierd things, like toe pain. I saw him once because "I can't see when I close my eyes." He presented with left upper abdominal pain once that radiated up into his chest. Obviously, with his schizophrenia, he wasn't the best historian, but his described chest pain was pretty atypical. I looked back in the past year and he had been seen 5 different times for chest pain. Had never had a troponin drawn, just numerous normal EKGs. I threw on a troponin, just because I could, and it was elevated. He went for CABG 2 days later. Decreased my already low threshold for getting troponins. The day I saw him with the NSTEMI, his EKG was normal.

 

[Jeff698]

Jaracoba,

Your schizo patient with the NSTEMI is just one more piece of evidence that we're playing in a game where no hitters just aren't possible. Somethings are just going to be missed, no matter how careful we are. That was a good pickup.

Take care,
Jeff

 

[DaveinDallas]

Youngest I've heard of was from an endocrinology prof during a lecture on diabetes. Stated he'd seen an 18 y/o MODY patient with an anterior wall MI....

 

[leviathan]

Jesus. Im starting crestor now.

Not gona lie, I had to get some bloodwork done a few days ago and this thread made me ask the MD to request a lipid panel as well!

 

[Hard24Get]

The big question is: has seeing these young & "no/low-risk" patients with MIs changed your work-up?

On CCU we had a 25yo, sl obese with Type II DM who had a STEMI assoc with v-fib arrest, a 27yo with no risk factors we stented, and a 30yo with no risk factors we sent for CABG, tons of 30 year olds with single-double vessel lesions - this was all during my one month on service! Had a 38yo with no risk factors in the ED who had BTW chest pain after what sounded like a mechanical fall there for a lip lac and was criticized for ordering enzymes, but it was an NSTEMI and he had a tight RCA lesion stented the next day.

I used to scoff at the possibility of an MI in those under 40 unless they had risk factors like DM or a dyslipidemia, now I trying to talk myself out of ordering enzymes all the time.

Am also watching my diet and being more faithful to my exercise program

 

[EM2BE]

Not gona lie, I had to get some bloodwork done a few days ago and this thread made me ask the MD to request a lipid panel as well!

I found donating blood once a year is another way to get the lipids checked.