Acute Myocardial Infarction: Etiologies and Mimickers in Young Patients

Abstract

Acute myocardial infarction is an important cause of death worldwide. While it often affects patients of older age, acute myocardial infarction is garnering more attention as a significant cause of morbidity and mortality among young patients (<45 years of age). More specifically, there is a focus on recognizing the unique etiologies for myocardial infarction in these younger patients as nonatherosclerotic etiologies occur more frequently in this population. As such, there is a potential for delayed and inaccurate diagnoses and treatments that can carry serious clinical implications. The understanding of acute myocardial infarction manifestations in young patients is evolving, but there remains a significant need for better strategies to rapidly diagnose, risk stratify, and manage such patients. This comprehensive review explores the various etiologies for acute myocardial infarction in young adults and outlines the approach to efficient diagnosis and management for these unique patient phenotypes.

Keywords: acute myocardial infarction; atheromatous; nonatheromatous; young.

Figure 1. Pathogenetic phenotypes of acute myocardial infarction in young adults.

AMI indicates acute myocardial infarction; and SCAD, spontaneous coronary artery dissection.

Figure 2. An approach to manage spontaneous coronary artery dissection.

ASA indicates aspirin; CABG, coronary artery bypass graft; DAPT, dual antiplatelet therapy; IMH, intramural hematoma; LV, left ventricle; PCI, percutaneous coronary intervention; and SCAD, spontaneous coronary artery dissection.

Figure 3. Diagnostic algorithm for evaluation of acute myocardial infarction in young patients.

AMI indicates acute myocardial infarction; CAD, coronary artery disease; CCB, calcium channel blocker; MINOCA, myocardial infarction with nonobstructive coronary arteries; and SCAD, spontaneous coronary artery dissection.