Chirumamilla Yashitha, Edupuganti Srujan, Alkotob Luay
Internal Medicine, Hurley Medical Center, Flint, USA.
Internal Medicine/Pediatrics, Hurley Medical Center, Flint, USA.
Cureus. 2023 Nov 17;15(11):e48975. doi: 10.7759/cureus.48975. eCollection 2023 Nov.
Premature coronary artery disease (CAD) is characterized by the presence of symptomatic atherosclerosis in the coronary circulation in males below the age of 55 and females below the age of 45. We present the case of a 21-year-old female with a past medical history of heart failure with preserved ejection fraction, poorly controlled diabetes mellitus, essential hypertension, nephrotic syndrome, dyslipidemia, and class I obesity who presented with complaints of worsening bilateral lower extremity edema and exertional shortness of breath. Given her physical examination findings and laboratory investigations, a diagnosis of heart failure exacerbation was made. Echocardiography revealed a significant change in ejection fraction from three months earlier, and thus, she underwent a nuclear stress test. She was found to have fixed perfusion defects in the inferior wall. A diagnostic left heart catheterization identified severe triple vessel disease affecting the left anterior descending, left circumflex, and right coronary arteries. The patient and her family opted against coronary artery bypass grafting, and she was discharged to pursue high-risk intervention as an outpatient. This case highlights the importance of strict regulation of modifiable risk factors for CAD even in teenagers and young adults as her disease process likely began several years prior to the ultimate development of triple vessel CAD.
早发性冠状动脉疾病（CAD）的特征是在55岁以下男性和45岁以下女性的冠状动脉循环中出现有症状的动脉粥样硬化。我们报告一例21岁女性病例，其既往病史包括射血分数保留的心力衰竭、控制不佳的糖尿病、原发性高血压、肾病综合征、血脂异常和I级肥胖，她因双侧下肢水肿加重和劳力性呼吸急促前来就诊。根据她的体格检查结果和实验室检查，诊断为心力衰竭加重。超声心动图显示射血分数较三个月前有显著变化，因此，她接受了核素负荷试验。结果发现她下壁有固定灌注缺损。诊断性左心导管检查发现严重的三支血管病变，累及左前降支、左旋支和右冠状动脉。患者及其家属选择不进行冠状动脉搭桥手术，她出院后作为门诊患者接受高风险干预。该病例强调了即使在青少年和年轻人中严格控制CAD可改变危险因素的重要性，因为她的疾病过程可能在三支血管CAD最终发展前数年就已开始。
