Is 20s too young to have triple coronary vessel disease?

Coronary artery disease (CAD) remains the leading cause of death in the US in both men and women. CAD is less frequent in younger population however when present CAD can have devastating consequences on the patient and the family. Case Report: We reported a case of 28 years old smoker male with a family history of CAD who presented with dyspnea on exertion. Labs were normal for cardiac enzymes and negative for D-Dimer. ECG on admission showed sinus rhythm at 71 bpm, RSR' in V1, S wave in I, Q wave in III, T wave inversion in III. Echocardiogram was done which right ventricular systolic function reduced mid portion, preserved at apex and base (McConnell's sign) consistent with acute pulmonary embolism. Patient was started on anticoagulation. Computed Tomography Angiography (CTA) was also done which was negative for any acute pulmonary embolism and anticoagulation was discontinued in the light of negative CTA. The patient is discharged from hospital with follow up in outpatient clinic. However, the patient came back to ED with worsening dyspnea. lab work was significant for elevated troponin I and ECG on admission showed normal sinus rhythm and S1Q3T3 pattern. Patient had Coronary Angiography which showed three vessel disease. Conclusion: Smoking is conventionally recognized as the most common risk factor for heart disease. CAD in young adults has a poor long term prognosis. Smoking cessation remains a significant challenge in younger population. More awareness and cessation measures are required to address this emerging situation. Given lack of warning signs in these patients, physicians need to be more aggressive in managing risk factors as CAD in younger patient can have adverse outcomes.