Abstract
Background: Sudden cardiac arrest due to coronary artery disease (CAD) is an important matter of research, particularly among young adults with no overt heart disease. Despite the rare incidence of myocardial infarction (MI) in patients aged < 45 years, it is necessary to identify the etiologies and the angiographic profile of the disease at a young age. Case report: A 21-year-old male with no past medical history presented with cardiac arrest. The patient was playing basketball, and he went for a water break. Then, he was found unconscious with no pulse. At the emergency department, the patient was hypoxemic (oxygen saturation: 88% on room air) with T wave inversions on electrocardiogram. Laboratory testing showed elevations of lactate, creatine kinase, creatinine, liver function parameters, lactic acid, and white blood cells. An echocardiogram showed an ejection fraction (EF) of 25% and acute non-ST elevation MI. Coronary angiography revealed a ruptured plaque and total occlusion of the proximal left anterior descending (LAD) coronary artery. The patient was intubated and he underwent a successful percutaneous coronary intervention (PCI) and stenting of the occluded LAD. An Impella blood pump (Impella 3.5) was implanted, which led to an improvement of the EF (42%). On the next day, the Impella device was removed; the patient passed the spontaneous breathing trial and was extubated. Patient started on carvedilol 3.125 mg twice daily, spironolactone 25 mg daily, aspirin, ticagrelor and sacubitril/ valsartan. Follow-up was advised at the outpatient clinic for the possible placement of an automated implantable cardioverter defibrillator. Conclusion and clinical implications: Among young patients with MI due to ischemic cardiomyopathy, echocardiogram and coronary angiography are diagnostic, and emergency PCI results in a significant improvement.
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