Double Trouble-Hyperhomocysteinemia and Lipoprotein(a) Induced Myocardial Infarction in Very Young - A Case Report

Background Acute coronary syndrome is a category that includes unstable angina, non-ST-elevation myocardial infarction (NSTEMI), and ST-elevation myocardial infarction (STEMI). Currently, the most significant cause of death globally is coronary artery disease. It is generally not suspected in a young person, especially without a significant family history. Hyperhomocysteinemia and high lipoprotein(a) are important risk factors and can be used in screening tools. Case presentation A 23-year-old male presented with an evolved anterior wall myocardial infarction, which was confirmed by ECG findings and Echocardiography findings. Subsequent coronary angiography was suggestive of a Single vessel with branch vessel disease, which was successfully revascularised with bifurcation stenting. OCT study of the lesion was suggestive of fibro atheromatous lesion with thrombosis. On workup, high lipoprotein(a) and hyperhomocysteinemia were found to be the risk factors for his disease. Conclusion Thus, Lipoprotein(a) and familial hyperhomocysteinemia may not always be associated with a family history of young ASCVD and are important risk factors for screening Intracoronary imaging should be used liberally to understand pathophysiology of the disease and also optimising interventions in such cases