Clinical and angiographic features in patients under 35 years with a firstQ wave acute myocardial infarction

Sixty patients less than 35 years with a first Q wave acute myocardial infa rction were prospectively studied to evaluate their features, risk factors and evidence of any viral infection. Typical chest pain was present in 98.3 % with Q waves and ST segment elevation in all. None had hypotension or car diogenic shock. Smoking was the most common risk factor (81.7%). Mean total cholesterol was 5.74 (+/-1.42) mmol/l. History of a viral illness was pres ent in 28.3%, severe emotional stress in 21.7% and exhausting physical acti vity in 18.3%. Mean left ventricular diastolic and end systolic volumes wer e increased (90.11+/-22.5 ml/m(2)) and (46.62+/-20.46 ml/m(2)), respectivel y. The ejection fraction was depressed (49.71+/-1.6%). Triple vessel diseas e was seen only in 6.8 and 26.7% had insignificant or no coronary artery di sease. Left anterior descending artery was most frequently involved (66%). None had left main involvement. Coronary ectasia was present in 11.7%, intr acoronary thrombus in 28.3% and 40% had collaterals. Patients with no signi ficant disease had no diabetes, a smaller number had a raised total cholest erol or smoked and had a lower ejection fraction. Patients from the Indian subcontinent who had fewer conventional risk factors, had more severe disea se than those from the Arab world suggesting that other etiological factors need investigation. (C) 1999 Elsevier Science Ireland Ltd. All rights rese rved.