Dr. Salil Shirodkar
Sr. Consultant
Cardiology
Nanavati Super Speciality
Hospital, Mumbai

Dr. Harshad Limaye
Sr. Consultant
Internal Medicine
Nanavati Super Speciality
Hospital, Mumbai

THE CASE

A 17-year old boy, a regular football player, recently selected for district level, came to Emergency department of Nanavati Super Speciality Hospital with severe chest pain and back ache, multiple episodes of vomiting and respiratory distress while playing football. The patient was non-diabetic and non-smoker. But had history of similar complaints around a month back while playing football which was treated with antacids and oral pain killers.

The patient was on homeopathy medicine for one month before this episode. There was no family history of Coronary Artery Disease (CAD) and Dyslipidemia.

THE PROCEDURE

ECG was performed which showed Myocardial Infarction (Heart Attack). The patient was unstable with fast heart rate, low blood pressure and laboured breathing. Further examination revealed that he was in cardiogenic shock (which is a life-threatening condition) for which he was electively put on ventilator and an intra aortic balloon pump was inserted to support his heart function as the heart pumping was low.

On emergency basis, Coronary Angiography was done, which revealed total Thrombotic Occlusion (containing blood clots) of mid Left Anterior Descending artery (LAD) which was tackled using thrombus aspiration and dilatation with a balloon. The procedure showed good result.





THE RESULT

The patient was later shifted to the cardiac intensive care unit for further monitoring and subsequently his vital parameters improved. Because of the timely intervention and quick response from the entire team of doctors, the patient had recovered well and was discharged without any morbidity. He will be able to lead a normal life but is restrained from playing football for sometime.

DISCUSSION

All the biochemical work up of the patient was normal. Despite detailed evaluation and the combined efforts of the team involved including a Cardiologist, Physician, Haematologist and Rheumatologist, the exact cause of the Myocardial Infarction could not be ascertained in such a young patient. Perhaps, genetic factors and other undetectable causes may still lead to acute coronary syndrome in young people.