Key result
Advanced imaging and genetic testing unmask severe CAD and an LDLR mutation in persistent ectopy.
Why the study?
Coronary artery disease is uncommon in young adults, and atypical presentations such as ventricular arrhythmias can obscure ischemic pathology and delay diagnosis, particularly in women.
Case Report (n=1)
No
Persistent ventricular arrhythmias following a presumed viral illness in young adults should prompt advanced imaging and investigation to rule out occult coronary artery disease and underlying conditions such as familial hypercholesterolemia.
May prompt CAD evaluation in young adults with presumed myocarditis and ectopy; this case report leaves open broader screening recommendations.
BACKGROUND: Coronary artery disease (CAD) is uncommon in young adults although rising in Southeast Asia. Myocarditis is typically considered in cases where viral symptoms precede cardiac injury. Atypical presentations of CAD, including ventricular arrhythmias, can obscure ischemic pathology and delay diagnosis especially in women compared to men. CASE SUMMARY: Significant coronary stenosis due to familial hypercholesterolemia was discovered through cardiac magnetic resonance imaging, multislice computed tomography coronary angiography, echocardiography, and coronary catheterization to overturn an original diagnosis of postviral myocarditis. DISCUSSION: CAD in younger people is associated with traditional risk factors such as smoking, dyslipidemia, diabetes, South East Asian descent, and a family history. The identification of a heterozygous low-density lipoprotein receptor mutation confirmed (familial hypercholesterolemia) in this patient and was a critical contributor to this patient's early-onset CAD. TAKE-HOME MESSAGES: Persistent arrhythmias should prompt further evaluation, including advanced imaging, to rule out occult CAD. Myocardial scarring seen after a presumed viral illness does not always indicate myocarditis in a young person.
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Hinh et al. (2025) conducted a case report in Coronary artery disease and familial hypercholesterolemia (n=1). Advanced cardiac imaging and genetic testing was evaluated on Diagnosis of underlying etiology for persistent ectopy. Advanced imaging and genetic testing in a 32-year-old woman with persistent ectopy and presumed myocarditis unmasked severe coronary artery disease and a heterozygous LDLR mutation.
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