ST-Elevation Myocardial Infarction in an Adolescent

Abstract

Myocardial infarction (MI) in the elderly is often due to atherosclerotic accumulation, while an MI in younger patients is often due to embolic events. An embolic MI is rare, accounting for 2.9% of all MIs, but has a higher risk of morbidity and mortality. The most common causes of embolic MI are infective endocarditis, atrial fibrillation, valvular heart disease, prosthetic heart valve, and mural thrombus. We present a unique case study of an ST-elevation MI (STEMI) in an adolescent, with none of the aforementioned risk factors. Our case reports a 17-year-old Caucasian male who presented to the emergency department with substernal chest pain that started while he was watching television. The pain was severe, and radiated down his left arm and up his left neck. Social history and family history were unremarkable. Vitals were within normal limits. The telemetry did not demonstrate any abnormalities. An electrocardiogram (EKG) was performed, as a rule-out, and surprisingly demonstrated an STEMI in the anterior leads with focal ST-segment depressions in the inferior leads. Cardiac catheterization was performed that demonstrated 100% stenosis in the middle to distal left anterior descending (LAD) artery. A stent was unable to be placed due to the small caliber of the occluded vessel, and medical management was started. Transesophageal echocardiogram (TEE) later demonstrated a patent foramen ovale (PFO).




J Med Cases. 2016;7(12):519-521
doi: https://doi.org/10.14740/jmc2650w