Background: Acute myocardial infarction in a very young female with a maternal history of premature coronary artery disease and no other risk factors is rarely suspected due to its low probability. However, this should not deter a physician at making the appropriate diagnosis and management. An aggressive approach with medical and percutaneous coronary intervention in a non-ST elevation MI in this group may have a good long-term outcome.
Case: A 27-year-old active, female, Filipino, single, normal body mass index, non-smoker non-alcoholic drinker, no use of recreational drugs, no previous hospitalization and comorbidities presented with sudden onset severe angina accompanied by diaphoresis and dyspnea. She was immediately brought to a local hospital, 12LECG showed T wave inversion on the inferior leads, troponin I was positive at 0.51ng/ml (0-.08) She was given aspirin, followed by clopidogrel in which she developed periorbital edema, dyspnea and was treated immediately with intravenous hydrocortisone and maintained on cetirizine and prednisone for 5 days. The clopidogrel was shifted to cilostazol. A coronary angiogram was done which showed a severe coronary artery disease at proximal right coronary artery. She underwent percutaneous coronary with stenting and was discharged stable and improved.
Conclusion: In a very young filipino female with acute chest pain, a family history of premature coronary artery disease should raise our suspicion of acute myocardial infarction. The diagnosis of non ST elevation MI in this group may be best treated with medical and percutaneous coronary intervention. Aspirin plus Cilostazol is a cost effective alternative for long term use and may prevent coronary in stent thrombosis.