26 yo Male, Acute MI

[slag6078]

26 year old male, 5’ 11’’, 165 lbs. Father had MI and triple bypass at 48, both paternal grandparents had MI.  No personal history of high chol., high blood press., smoking or diabetes.  First chest pain 12/11/06, Acute MI 12/14/06, PTCA 12/15/06 during which three Taxus DES were placed in the LAD, and one Taxus DES was placed in the 2nd diagonal.  Both vessels were 100% blocked.  A Persantine nuclear imaging stress test was performed on 1/25/07 and found that the front of my heart was not receiving enough blood.  PTCA performed 2/1/07, found LAD suffered complete restenosis (100% blocked).  Doctor was unable to clear blockage using a variety of wires and balloons.  (Total cholesterol at this time was 125 (from a high of 169 during the first PTCA) following 40mg Lipitor treatment.)  Currently scheduled for another PTCA 3/1/07, the plan is to attempt to get through blockage and re-stent.
How rare is this condition at my age?
Should I seek a second opinion from another cardiology group?  The same doctor, (by all accounts the best stent doctor in Buffalo, NY) performed the first two PTCAs and is scheduled to perform the third.
During the investigation into my heart disease, a stomach ultrasound showed that my right kidney was abnormal.  After further tests (renal nuclear medicine scan, bloodwork) it was discovered that my right kidney is approximately 12X18 cm, completely cystic, and non-functioning.  Current diagnosis by the urologist is that this is a congenital problem, and nephrectomy is unnecessary.  What possible links could exist between my kidney failure and CAD?

[Forum-M.D.-bkj]

slag,

thanks for the post.

How rare is this condition at my age?

Exceedingly, even in patients with multiple risk factors. Coronary disease forms in patients at very young ages, but the severity of your disease is beyond what we usually see.

Should I seek a second opinion from another cardiology group?

I dont think there would be anything wrong with seeking a second opinion given the severity of your disease and the early onset. I might even recommend seeking an opinon at a specialized center.

good luck

[Al Dente]

Sorry to hear you've been hit by CAD at an early age.  It can be a real battle as a young person getting people--even hospital personnel to understand CAD related heart issues in young people.  I was diagnosed at 28--I have a very bad family history.

I absolutely if I were you would go to a tertiary care center.  A short drive over I-90 gets you to CCF--they have excellent cardios, urologists, and nephrologists.  A lipid specialist I think would be of benefit (usually preventative cardiologists that specialize in lipids are helpful in conjunction with interventional cardiologists).

Have you been on lipid treatment before this event?  I was luckily found to have a very bad lipid problem in my late teens and was started on statins which have made a big difference.

Good luck!

[EchoTech]

Very rare indeed.  The youngest person that I've had a run in with that had CAD was 28 and a female which just makes it that much rarer.  I don' think it would be a bad idea to get a second opinion at CCf in cleveland or even UPMC in Pittsburgh.  You are a rare case and they would take a particular interest in you for sure.

[Lynn8889]

Given your name, I'd like to ask you - can you tell based on an Echo if one has CAD or if there is suspicion of CAD just by an Echo?  I am having an Echo done in a couple of weeks.

[EchoTech]

  There has to be significant CAD to be seen on a regular echo.  That translates to  roughly 50%-70% blockage in the bore of the vessel before we start seeing wall motion abnormalities on the echo.  Wall motion abnormalities show up in how fast the muscle contracts when it is in squeeze mode.  The slower the squeeze in that section, the less blood flow that it has.  TO sum it up, we can see significant disease, but not see anything if there is a lesser blockage.  I hope this helps.

Good night and good luck.

[anacyde]

I'm sorry to hear you're going through all of this right now.  It must be incredibly frustrating.  I'm your age.  

I agree with AlDente.  Buffalo is only a short drive from Cleveland Clinic, and they have the best heart care in the world.  That's the one thing I like about living in this part of the world.  The weather stinks but we have quick access to absolutely amazing medical care.  I would definitely go to CCF for a second opinion.  I'm not saying your doctor isn't awesome, I'm sure he is - it's just that sometimes two sets of eyes can see more things.

I wish you the very best and I hope everything gets better from here.

[Al Dente]

Thanks Anacyde.  Echotech has a good suggestion as well--UPMC Presby is a good hospital.  I feel CCF does a great job, and it's #1 on my list for care.  They've managed to help solve my very complicated case.

It's always worth a 2nd opinion, however getting too many eyes can cause some issues.  Narrowing down a few highly trusted and caring physicians is very, very important.  Trust is key.

[slag6078]

Thank you all for your kind words and suggestions.  My third PTCA has been rescheduled for March 8.  If they are unable to clear the blockage, a referral to the Cleveland Clinic will be the next step.

It has been a trying experience having this happen so early in my life.  The worst part of it all has been sitting in my apartment for the last three months, bored out of my mind.  Particularly frightening because my wife is due with our first child in September.  All I want to do is take care of her during this time, but I'm forbidden from doing the things that she cannot do!

[gary001]

I also had an mi at 26 and another at 36 I'm now 37 and having echocardiogram today, I was supposed to have a heart bypass last year but I think they forgot about me. It is rare to read about someone who is suffering the same as myself. I have two small kids also and understand the emotions you are going through. I hope all goes well today for you, I will keep a look out for any further info you post. thanks

[slag6078]

Gary-

It is great to hear from someone who has been in the same position as me.  I have tons of questions for you, probably won't think of all of them now.

How was your heart disease treated after your first MI?
How often did you have testing performed between your first & second MIs?  (Stress, echos, etc)
What level of activity were you able to return to after your first MI?
Was your heart attack caused by atherosclerosis, or were there other problems with your heart?

Thanks again for posting a reply!

Travis

p.s.

My third angiogram was performed on March 8, and it was unsuccessful.  The cardiologist performing the intervention stated that the blockage had hardened and he was unable to get through it.  He said that the next step is probably just to live with that artery blocked (distal LAD after 2nd diagonal.)  I'm going to go to Cleveland in the next couple of weeks for a second opinion.