Advanced Coronary Atherosclerosis and Fatal Myocardial Infarction in Mild Dyslipidemic, Low Risk Young Man: A Case Report With Literature Reviewed

Abstract

A cute myocardial infarction (AMI) at young age, below 45 years, is rare and little known in clinical practice. Most victims are male and share common conventional coronary risk factors including cigarette smoking, a family history of premature coronary artery disease (CAD), dyslipidemia, hypertension, diabetes mellitus and being overweight or obese. 1-5 We reported a fatal AMI from advanced atherosclerosis in a relatively young man who had none of the aforementioned risk factors except dyslipidemia which was well controlled. Thus, all systemic risk score identified him as a low risk candidate for developing future cardiovascular disease and precluded primary prevention. Case Report A 43-year old man, regular tennis player, had been well, with a physically active life style for decades. In 2010, at the age of 39 years, he was diagnosed with hypercholesterolemia, with a total cholesterol of 260 mg/ dl. With dietary control, regular exercise i.e. swimming every day, jogging on weekend and simvastatin 10 mg/day, his lipid was well under control, see Table 1. At the same time, he was diagnosed with a herniated disc (L4-5 level) and spinal canal stenosis so surgery was recommended. He used to smoke cigarettes, for a year, and stopped seventeen years earlier. Preoperative physical examination was unremarkable; body mass index (BMI) was 25, BP was 110/70 mmHg and pulse rate was 76 beats per minute. Chest film was normal. Screening ECG showed regular sinus rhythm, normal QTc and had Q wave in lead III, see Figure 1. The total cholesterol was 164 mg/dl, triglyceride was 50 mg/dl. His father drank alcohol and had died during sleep in his mid 30's. His brother and one uncle also had dyslipidemia (no details available) but none of them had known cardiovascular diseases. In Jan 2011, microdiscectomy and foraminostomy were uneventfully performed and allowed him to play tennis for two hours a day instead of swimming. Serial blood test showed fasting glucose of 91 mg/dl, total cholesterol of 177 mg/dl, triglyceride of 47 mg/dl, HDL-cholesterol of 78