Positive Family History as the Single Traditional Risk Factor for Developing Extensive Very Premature Coronary Artery Disease: A Case Report
A 22-year-old man was referred to our center for CABG. The patient’ illness had started one month before admission with an onset of acute MI. His past medical history did not present any positive clue of CHD. He was 71 kg in weight and 180 cm in height, which meant that his body mass index (BMI) was in safe limits (21.91 kg/m2). Risk factors such as diabetes, smoking, obesity, and dyslipidemia were not seen in his history, but his family history for CHD was positive. His father had died at 38 years of age because of sudden cardiac death and his mother was a known case of ischemic heart disease. The patient had no history of the use of legal or recreational drugs, and his family history was negative for any hereditary or metabolic disorders.\nThe results of laboratory tests conducted on admission were as follows: normal complete blood count (white blood cell [WBC] = 6600 / mm3, red blood cell [RBC] = 5.39 × 106 / mm3, hemoglobin [Hgb] = 16.1 mgr/dl, and hematocrit [Hct] = 45.7%); normal hepatic transaminases (alanine aminotransferase [ALT] = 29 IU/L and aspartate aminotransferase [AST] = 20 IU/L); normal-range blood serum electrolytes; total cholesterol of 126 mg/dl; triglyceride of 92 mg/dl; high-density lipoprotein (HDL) of 26 mg/dl; low-density lipoprotein (LDL) of 84 mg/dl; very low-density lipoprotein (VLDL) of 18.4 mg/dl; LDL/HDL ratio of 3.2; and cholesterol/HDL ratio of 4.8. Additionally, creatine kinase MB (CKMB) and troponin on the day before surgery were 5.41 ng/ml and less than 3 ng/l, respectively, and coagulative tests showed a normal span. The patient’s blood group and Rh was O positive.\nOn physical examination, the patient’s blood pressure was 105/80 mmHg with a heart rate of 100 beats per minute. In heart auscultation, S1 and S2 were normal and the respiratory system was clear on examination. Preoperative electrocardiography revealed nonspecific changes in T wave.\nEchocardiography demonstrated a left ventricular end diastolic volume (LDEDV) of 96 cc, left ventricular end systolic volume (LVESV) of 48 cc, and ejection fraction (EF) of 42%. Furthermore, there was an abnormal septal motion, hypokinesia, in the septal wall and the mid-portion of the anteroseptal wall. The heart valves had mild mitral regurgitation and trivial tricuspid regurgitation.\nAngiography demonstrated that the left main coronary artery was 70% diseased. Three other coronary arteries, i.e. the left anterior descending artery, diagonal 1 artery, and right coronary artery, had severe stenosis ( & ). There was also ostial stenosis in the ramus intermedius. The left circumflex coronary artery was patent, and the EF based on angiography was 45%.\nThe patient underwent CABG without any complication. Two days after surgery, laboratory tests revealed CKMB of 4.74 ng/ml and troponin of 437.7 mcg/l.\nOn postoperative electrocardiography, the ST segment was slightly elevated in leads II, III, AVF, V5, and V6. The patient was discharged from the hospital in good healthy condition five days after surgery. Postoperative follow-up of the patient, conducted one year later, showed that he was still symptom free and that he had no traditional risk factors other than a positive family history of premature CAD. Additionally, he was on stating β blocker and amino salicylic acid.