MI at 23?

  1. I had a very strange case today and I was wondering if anyone has ever heard anything similar. The patient was a 23 yo female who presented with CP and abd. pain. The pt was holding her chest and very uncomfortable. She said the pain radiated to her left arm and left side of her face. She also had nausea. The patient had no cardiac medical history and her vitals were stable. She had gastric bypass 6 months ago. I thought she might be have a PE, but I didn't hear any murmer and her oxygen level was 99 percent on room air. I honestly didn't think she could be having an MI even with a history of obesity, but I pushed for a bed for her inside because she was so uncomfortable. The patient ended up having a troponin level of 30. Has anyone ever heard of anything similar?
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    About MikeyBSN, BSN, RN

    Joined: Dec '04; Posts: 464; Likes: 524
    ER Nurse; from US
    Specialty: 7 year(s) of experience in ED


  3. by   TheCommuter
    I knew of a female methamphetamine addict who suffered an MI at age 22. MIs are capable of afflicting people at all ages. Heck, I even have chest pains during times of stress with some radiation down my left arm.
  4. by   medicrnohio
    I had a young patient with similar symptoms once. The cardiac enzymes kept going up and up. Finally in the AM we sent patient to ICU. Turns out the patient had endocarditis.
  5. by   TazziRN
    The youngest one I saw was 19 or 20. Kept coming into the ER several times, negative labs (this was before Trop I's), vague symptoms. Cardiac workup by a specialist showed nothing. He came back the night I was working and the doc ordered stuff, told us to wake him up when everything came back. Ten minutes later I was banging on his door. He opened it and growled "What?!?", and I shoved the EKG in his face. The kids was tombstoning! There was a staff meeting that morning at change of shift and we held it in the trauma room. A day shift nurse came crashing in and grabbed the crash cart and said "Your kid coded!" He made it but it shook all of us up, including the doc. The boy had no precipitating factors, no history of drug use, nothing.
  6. by   Lacie
    Long time ago but my father was only 26 and passed from Sudden cardiac death. Non-smoker, non-drinker, very physically active and career military. No history of anything. Many times we think a healthy appearing young patient comes in with symptoms related to cardiac it's often tossed off as "chest wall pain" (muscular) or GI related. Consider also the increased amount of junk food and much less activity levels in todays youth. We should be testing routinely for increased cholesterol, lipid levels, etc much younger than what the norm is. I had to request these test specifically for my sons at around age 17 and the doc asked me "WHY?". Pediatricians never recommended nor ordered them previously. Well because I wanted it done simple as that lol. My 17 y/0 150lb, 6'3", football player's level was 218!! Diet changes he's remained at 186 now.
  7. by   AtlantaRN
    yep, but a coke head...... Could be the physical from the gastric bypass? How large was this person prior to surgery?

    Couple of RNs i've worked with have had gastric bypass and post surgery 1 had a bout of Rheumatoid arthritis and still can't work (she is in her late 40's); another is 95 lbs and is extremely malnourished (won't eat/can't eat/anorexic).

  8. by   JentheRN05
    My baby brother - well my only brother, had his first at 24. He has hypertrophic cardiomyopathy. Sadly it appears as if I have it too. I've had 3 heart attacks and I'm only 35, he's had 6 and he's 32. (5 of his were induced via cardiac ablation, with him fully awake, and the pain meds didn't work on him at all, so he felt the entire heart attack, even coded once with a cardiac cath in his groin. Our family sux, health wise. What's worse, I have no insurance. *sigh* I just hope to get it soon.
  9. by   Dixielee
    Recently we had a 10 year old boy come into the ER with crushing chest pain. Got an EKG and he was having big changes. He arrested very quickly but did make it. Went to the cath lab and found congenital anomolies including dextrocardia that had been undiagnosed. Parents thought he was perfectly healthy. His pain started while in a hot tub after a long afternoon in the sun. Probably dehydrated among other things.
  10. by   augigi
    I was going to suggest HCM/HOCM as well. It's the most common cause of sudden cardiac death in young males, but can occur in females as well. You'd have to have it reasonably severely to get an MI, but it happens.

    In good news, my dad has HOCM and has made it to age 62 so far, still smoking and drinking (doh), meds only (no ablations).
  11. by   nightangel99
    I had a 17 year old present with the same symptoms..had EKG changes consistent with an MI and an elevated troponin. The cardiologist diagnosed him with pericarditis....:smackingf
  12. by   glea1022
    There is a major difference between the two terms "sudden cardiac death" and "myocardial infarction" although both are commonly referred to as heart attacks. Sudden cardiac death refers to an arrhythmia (like v-tach/v-fib) that usually occurs due to cardiomyopathy or an electrical disturbance. It can also occur as a result of a myocardial infarction (lack of blood flow down a coronary artery, resulting in tissue ischemia/injury/necrosis). MI's cause sudden cardiac death (VT/VF) by disrupting the electrical conduction in the heart tissue. The two terms are NOT interchangeable
    In answer to the original question, either or both of these conditions can occur in people of any age (especially, as someone mentioned, with the epidemic of poor diet and obesity). However, the symptoms described by the original poster could indicate an MI (somewhat unlikely, unless on drugs), PE, complications of the gastric bypass, endocarditis, or pericarditis. It would be interesting to know what her EKG showed, as well as a D-dimer and CT scan (to rule out PE). An echocardiogram would help determine pericardial effusion or endocarditis (blood cultures would be good too).
    BTW, anyone who has had even one episode of arrhythmia is a candidate for an implanted defibrillator. They are expensive, but save lives!
  13. by   augigi
    You are quite correct - however I was referring to SCD in HCM/HOCM patients in reply to JentheRN's post.
  14. by   JentheRN05
    That is so nice to hear augigi. Seriously. You can read over and over that the chances of survival with hereditary HCM - which is actually quite low - living to the age of 50, so it is refreshing to hear of someone living to your fathers age. Thank you. I have always thought that I would be lucky to see 50. Mines pretty severe, my heart is 2-3x the normal size. But my brothers is clinically worse. Either way it is a scary thing.