van der Schoot G G F, Anthonio R L, Jessurun G A J
Department of Cardiology, Treant Zorggroep Scheper Ziekenhuis, Emmen, The Netherlands.
Neth Heart J. 2020 Jun;28(6):301-308. doi: 10.1007/s12471-020-01408-y.
Worldwide, a myocardial infarction (MI) is an important cause of death. Acute MI occurs most commonly at an older age. However, the incidence of acute MI in adolescents is increasing. This is partly due to an increase in cardiovascular risk factors (e.g. smoking, unhealthy diet), which might lead to premature atherosclerosis. However, several non-atherosclerotic causes of MI in adolescents are also described in the literature, such as vascular spasm due to the use of cocaine. We may assume that acute MI is not considered to be the most likely cause of chest pain in adolescents. Therefore, the risk of a dramatic outcome in this patient category may be significant. This point of view article addresses the pathophysiological process and subsequent diagnostic approach in adolescents with MI resulting from either premature atherosclerosis or of non-atherosclerotic causes. Insight into the potential operational mechanisms of the coronary artery incident may have a major impact on the clinical course following admission. We would like to underline that a personalised clinical approach remains of utmost importance in each patient treated by protocolised medicine. This is particularly true when acute MI occurs at a young age, since the underlying cause more frequently differs from the conventional atherosclerotic process in this patient category.
在全球范围内，心肌梗死（MI）是一个重要的死亡原因。急性心肌梗死最常发生在老年人群中。然而，青少年急性心肌梗死的发病率正在上升。部分原因是心血管危险因素（如吸烟、不健康饮食）增加，这可能导致过早出现动脉粥样硬化。然而，文献中也描述了青少年心肌梗死的几种非动脉粥样硬化病因，如使用可卡因导致的血管痉挛。我们可以认为急性心肌梗死并非青少年胸痛最可能的病因。因此，这类患者出现严重后果的风险可能很大。这篇观点文章探讨了因过早动脉粥样硬化或非动脉粥样硬化病因导致心肌梗死的青少年的病理生理过程及后续诊断方法。深入了解冠状动脉事件的潜在作用机制可能对入院后的临床病程产生重大影响。我们想强调的是，在采用规范化治疗的每一位患者中，个性化的临床方法仍然至关重要。当急性心肌梗死发生在年轻人身上时尤其如此，因为这类患者的潜在病因通常与传统的动脉粥样硬化过程不同。
