Heart Attack in the Young: A Challenging Case of Survival

Mahadev Heart Care

Heart Attack in the Young: A Challenging Case of Survival

On September 12, a 27-year-old man, Mr. V, arrived at the hospital after suffering a massive heart attack, diagnosed as an extensive anterior wall myocardial infarction (MI). The situation was further complicated by cardiogenic shock and pulmonary edema, a combination that posed significant challenges to his survival. The patient’s left ventricular (LV) function was critically impaired, with an ejection fraction (EF) of just 15%, and a clot was detected in the LV on his echocardiogram.

During an emergency angiogram, multiple blockages were found in his coronary arteries, necessitating an urgent primary angioplasty. The procedure was conducted under intra-aortic balloon pump (IABP) support, and Mr. V was placed on a ventilator with high-dose inotropic support to stabilize his heart function. Despite these efforts, he encountered multiple complications, including multi-organ dysfunction syndrome (MODS) due to acute kidney injury (AKI), ischemic hepatitis from cardiogenic shock, sepsis, and severe thrombocytopenia. To manage the bleeding risks associated with his condition, six units of single-donor platelets (SDP) were administered.

Dr. Mahadev Swamy B, Interventional Cardiologist

Mr. V’s family was informed about his critical status, and the option of using ECMO (extracorporeal membrane oxygenation) was discussed if his condition worsened. Fortunately, signs of improvement began to emerge on the second day, allowing for the gradual withdrawal of IABP support after 72 hours. Over the next few days, his inotropic medications were slowly tapered off. By then, his AKI had resolved, though he experienced recurrent bleeding and clot formation in his endotracheal (ET) tube, necessitating frequent tube changes. After six days, Mr. V was successfully extubated.

However, another complication arose: aspiration pneumonia, which required a few days of non-invasive ventilation (NIV) and corticosteroid treatment. Further evaluation revealed Mr. V had severe hyperhomocysteinemia, a condition contributing to premature coronary artery disease (CAD), alongside being overweight. These factors highlighted the complex nature of his case and the risks associated with lifestyle and genetic predispositions.

Despite these setbacks, Mr. V's recovery progressed, with his LV function improving to an EF of 35% by the time of discharge. After an intense 12 days of hospitalization and a team effort from medical staff, Mr. V was discharged on September 24, marking an inspiring journey of resilience and recovery.

This case highlights the growing incidence of heart attacks among young adults, often exacerbated by lifestyle and genetic factors. Mr. V’s story serves as a powerful reminder to prioritize heart health early, remain vigilant about risk factors, and seek timely medical intervention.

Dr. Mahadev Swamy B

Consultant Interventional Cardiologist