Early-Onset Myocardial Infarction in a 13-Year-Old With Homozygous Familial Hypercholesterolemia Managed by PCI

Figures

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  Figure 1. 12-Lead Electrocardiogram Showing ST-Segment Elevation in the Anterior Precordial Leads V1 Through V4, With Reciprocal ST-Segment Depression in the Inferior Leads The findings are consistent with an acute anterior wall ST-segment elevation myocardial infarction in the clinical context of cardiogenic shock.

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  Figure 2. Elbow and Forearm Xanthomas (A to C) Multiple large, yellowish nodular swellings over the extensor surfaces of both elbows and forearms, consistent with tuberous and tendinous xanthomas. Lesions show both discrete nodules and coalescing plaques. These lesions had been present for several years, gradually increasing in size and number.

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  Figure 3. Knee Xanthomas Extensive nodular xanthomas over the anterior aspects of both knees, forming confluent lobulated plaques. The lesions demonstrate the characteristic firm, rubbery consistency on palpation, typical of long-standing hypercholesterolemia.

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  Figure 4. Buttock and Posterior Thigh Xanthomas Multiple nodular and confluent xanthomas over the buttocks and posterior thighs. These large, coalescing lesions are seen in areas exposed to pressure and friction, consistent with the distribution commonly reported in homozygous familial hypercholesterolemia.

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  Figure 5. Achilles Tendon Xanthomas and Corneal Arcus (A) Bilateral corneal arcus noted on close examination, indicating long-standing hyperlipidemia even at a young age. (B) Prominent tendinous xanthoma over the Achilles tendon with firm, subcutaneous nodules.

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  Figure 6. Left and Right Coronary Angiograms (A) Left coronary angiogram (LAO cranial view) showing severe ostioproximal left main stem bifurcation disease extending into the proximal left anterior descending artery, with additional narrowing of the proximal left circumflex artery. (B) Right coronary angiogram (RAO cranial view) after crossover stenting from the left main stem into the left anterior descending artery, demonstrating optimal stent expansion and restoration of TIMI flow grade 3.

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  Figure 7. 12-Lead Electrocardiogram Obtained After Percutaneous Coronary Intervention Showing Resolution of ST-Segment Elevation in the Anterior Precordial Leads (V1-V4) With Evolving T-Wave Inversions, Consistent With Reperfusion and Postinfarction Changes After Successful Revascularization