Acute myocardial infarction in adolescents: reappraisal of underlying mechanisms

Abstract

Worldwide, a myocardial infarction (MI) is an important cause of death. Acute MI occurs most commonly at an older age. However, the incidence of acute MI in adolescents is increasing. This is partly due to an increase in cardiovascular risk factors (e.g. smoking, unhealthy diet), which might lead to premature atherosclerosis. However, several non-atherosclerotic causes of MI in adolescents are also described in the literature, such as vascular spasm due to the use of cocaine. We may assume that acute MI is not considered to be the most likely cause of chest pain in adolescents. Therefore, the risk of a dramatic outcome in this patient category may be significant. This point of view article addresses the pathophysiological process and subsequent diagnostic approach in adolescents with MI resulting from either premature atherosclerosis or of non-atherosclerotic causes. Insight into the potential operational mechanisms of the coronary artery incident may have a major impact on the clinical course following admission. We would like to underline that a personalised clinical approach remains of utmost importance in each patient treated by protocolised medicine. This is particularly true when acute MI occurs at a young age, since the underlying cause more frequently differs from the conventional atherosclerotic process in this patient category.

Keywords: Acute coronary syndrome; Primary percutaneous coronary intervention; Risk factors; ST-elevation myocardial infarction.

Fig. 1

Acute transmural ischaemia in the anterior wall with an expected occlusion before branching of the left anterior descending coronary artery

Fig. 2

a Left anterior descending coronary artery, occlusion at the ostium. b Result immediately after percutaneous coronary intervention

Fig. 3

a Electrocardiogram: Non-specific intraventricular conduction delay with a QRS of 124 ms and symmetrical peaked T waves, suspicious for the hyperacute phase of ischaemia. b Electrocardiogram: convex ST elevations in the inferior and anterior wall

Fig. 4

a Left anterior descending coronary artery, occlusion at the ostium. b Result immediately after percutaneous coronary intervention

Fig. 5

Virchow triad