International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. Computed tomography angiography (CTA) was also done which was negative for any acute pulmonary embolism, and anticoagulation was discontinued in the light of negative CTA. The patient was discharged from hospital with follow-up in outpatient department. However, the patient came back to emergency department with worsening dyspnea. Lab work was significant for elevated troponin I and ECG on admission showed normal sinus rhythm and S1Q3T3 pattern. Patient had coronary angiography which showed three vessel disease. IJCRI publishes Conclusion:Smoking is conventionally recognized as the most common risk factor for heart disease. The CAD in young adults has a poor long-term prognosis. Smoking cessation remains a significant challenge in younger population. More awareness and cessation measures are required to address this emerging situation. Given lack of warning signs in these patients, physicians need to be more aggressive in managing risk factors as CAD in younger patient can have adverse outcomes.