Having a STEMI in mid 40's...the search for underlying causes / answers for premature CHD.

[Fortunate1]

Hi Everyone,

My husband had a major STEMI in March 2023 with a full blockage of his circumflex artery. He was 44 years old and playing 5-a-side football in a local sports centre when he collapsed without warning. Thank goodness it happened there of all places however, as the swift actions of his team mates in administering CPR and using the defibrillator on site undoubtedly saved his life.

He was then rushed by ambulance to the regional HA centre and had PCI/stent inserted to enable reperfusion of his heart. The coronary angiogram and angioplasty procedure showed that he also had extensive narrowing of the other main arteries and the multi disciplined team (MDT) would make a call on next steps for treating them if he pulled through.

After the cath lab surgery he was placed in an induced coma and sent to ICU for recovery. He remained in ICU for 2 weeks, there were various complications caused by his fall at the time of the HA. It had caused a posterior nose bleed which means the blood flows back down the throat and not out of the nose and with all the blood thinners post stent procedure... the bleeding wouldn't stop and the blood was being aspirated into the lungs and causing nasty infections, then to add further complications he somehow caught COVID in ICU.

Thankfully, he eventually made it out of ICU and onto a normal cardio ward for a while whilst he got over COVID and built up and bit more strength to withstand the triple bypass that the MDT decided was his best course of treatment for the other arteries. The cardiothoracic team also did an amazing job on the CABG and have returned his ejection fraction to a near normal level. A couple of issues aside with developing Dressler's Syndrome and getting pleural effusions which sometimes had to be drained, his recovery and cardiac rehab has otherwise gone well. We are beyond lucky and so incredibly grateful for all the amazing skill and care from the doctors and nurses involved in getting him back to good health. He is of course now on all the medications you can throw at this including statins, ACE inhibitors, beta blockers, ezetimibe, aspirin and clopidigrel.

But here's the conundrum....no one so far can shed any light on why his arteries were so extensively blocked. All the usual tests (and even a few extra ones) were done in hospital and they can't find any particular reason for this to have happened. He's relatively young, no family history of CHD or heart attacks, no familial hypercholesterolemia (FH), he's was active/fit, not overweight (tall and slim), not diabetic, never smoked or took drugs and drank only occasionally and moderate amounts. His diet was also pretty good. His total cholesterol was just a little high (5.2), but his LDL and lipoprotein 'a' and cholesterol ratio was normal.

I could rationalise the fact that someone his age and in seemingly good health could be 'unlucky' to have had the heart attack in the first place with one artery blocking, but to have such extensive narrowing over all 4 major arteries without any of the major risk factors feels like there must be some underlying reason that we don't know about yet.

I am petrified that without knowing why this happened, the same thing could potentially reoccur over time in his new heart "plumbing" despite doing all the right things with diet and exercise and taking the drugs religiously. I think I am probably more anxious about this than he is (he still has total amnesia for a few weeks to a month or so before his HA).

In fairness his wonderful cardiologist has supported doing some additional investigations - so we are awaiting appointments with an autoimmune cardio specialist, a dyslipidaemia cardio specialist and a metabolic cardio specialist - to see if there are any additional tests/investigations he should have or specific courses if action he should take.

Sometimes I wonder though if I am just chasing rainbows ? Has anyone been in a similar situation and found an underlying cause? Is this just likely to result in more dead-ends and conclude that he really just was 'unlucky'. Is is right to keep 'turning over stones' in the search for answers or is my anxiety just sending us on a mission to nowhere?

Any advice greatly appreciated, thanks for reading.

[ChoochSiesta]

My story is very similar I managed to get to 49 when the heart attack happened totally out of the blue. A stent fixed that but 8 years later I needed a triple bypass. Nobody has ever been able to explain why but it does run in the family on my Mother's side. Why though is a mystery. I just get on with life - I can't do much else.

[Fortunate1 in reply to ChoochSiesta]

Thanks ChoochSiesta, as far as we know it doesn’t run in my husband’s family. His Mum is 87 and still going strong and his Dad passed a few years back from lung cancer, but perhaps in the broader family there may be something else. Perhaps acceptance with the hand you were dealt just comes with time. I hope you’re doing well now though

[Derfey in reply to ChoochSiesta]

Can I ask what your stenosis was like at 49, were all three arteries blocked at all?

[ChoochSiesta in reply to Derfey]

Yes, there was certainly narrowing but didn't cause problems at the time.

[Hatchjd]

A similar story in my family. My father had a heart attack at 34, 38, 48 and died at 52. My brother had a heart attack at 36 and 40 followed by CABG. Neither was overweight and both were plumbers working a physical job. I made it to 60 y/o (retired RN) and after an episode of jaw tingling went to A&E, this was followed by a stress test and angio. I had a 90% blockage in the LAD, 80% in LCX, and 40% in the RCA. I received 2 stents. I don't have high cholesterol, don't smoke or drink, eat healthily, and was circuit training 3 x a week. My sister who is 2 years younger had a cardiac workup following my stents and her arteries are clear with zero calcium. In my case, there is a hereditary factor but my sister got a lucky pass.

[Fortunate1]

Gosh, I’m sorry Hatchjd. Sounds like you and many of your family has really been through the mill with CHD. It feels like such a puzzle though…genetics, environmental factors and sheer luck! I’m such a ‘black and white’ type person - so I’m probably just driving myself mad looking for answers when so much of medical reasoning exists in the ‘grey’

[bluemoon572]

In some cases like your husband's, a high homocysteine level is found & may be a causative factor in extensive coronary atherosclerosis. It is treated with folic acid, vitamins B6&B12

[mesally]

Hello there, there has been a fair bit of media coverage recently about the increase of heart issues in younger people. Dietary, exercise, infections and jabs all being suggested as possibilities. We may find out in due course. Meanwhile, hope he continues to make good progress

[devonian186 in reply to mesally]

All those things you mention being true and I suspect we don't know anything as much as we think we do about health matters especially the heart.

Advice changes as one food is thought to be good then bad and vice versa. Fat was demonised now many think it good.

[Stentsandrun]

It's a huge shock, that's the only thing you can say with 100% certainty! As has been said above, I personally, having tried to fathom this for 6 years via research and forums, have come to the conclusion there is far more the medical establishment don't understand than what they do. This is not a criticism of them, far from it. Personally I think all your hubby can do is keep taking the pills and follow the mainstream advice of his professional advisors. You will find many unsubstantiated or flimsy alternative views, some of them even from medically qualified people, but the advice of Diet, Exercise and Statins etc is all we have at the moment, really. I have personally been diagnosed with high LP(a) but all the lipid clinic can tell me is that they think it might be a risk factor but then again they are not really sure - which says it all for me! They are researching drugs to lower it but they are not sure if it's a risk, apparently?? I think Heredity is very likely a big risk, but then again there are plenty of cases like your Hubby's. All you can really do is thank the stars he is still with us, and try and not let anxiety take over, which I did by focussing on running and making sure my diet is as good as possible, within reason. Good luck, we all, unfortunately, need it. It does get easier with time if you try not to let the gremlins in.

[Soundar1970]

Glad to read that your partner got the right attention, the critical 15 min !! There are many reasons that are not detected in normal course of testing...Stress is one major reason that has no measurement or detection !! ( beyond the BP readings !! ). The other is about how heart functions balancing various chemicals in it. Amino acids and Vitamin B6, B12 and even D are also key drives to keep the Homocysteine in balance there by keeping the heart healthy. If there is any deficiency in any of these that can trigger a silent heart issue like in your partner's case. The other is how heart functions with many micro-capillaries that keep the blood flow inspite of 100% blockage and leads to sudden collapse like this one....I just shared some facts that I have experienced but not necessarily the situation with your partner

[RailRover]

To echo other replies, there is certainly a good deal more that we don't know about everything. I was told after HA, stent, and later triple CABG that it is a palliative treatment for a progressive disease, so the tendency to build up plaque does continue post op. All we can do is to try our best to restrain the process through good diet, a healthy lifestyle and general best practice for monitoring. You are right to cover all the angles you can, but please don't obsess too much. It can be counterproductive because worrying about the maybes of the future will ruin, or perhaps even shorten, what you have right now. Live your life, be positive, and let that positivity rub off on him rather than your anxiety. Of course, we heart patients do worry about the effects of our condition on our loved ones more than we worry about ourselves.