Coronary artery disease in a young man with normal serum lipids.

The patient was born in Israel of Yemenite Jewish parents, and has lived in England since I962. On 30 August I968, when 23 years old, he experienced squeezing retrosternal pain for 4 hours, and was admitted to hospital. None of his family has suffered from ischaemic heart disease. He smoked IO tO I5 cigarettes a day and followed a conventional Western diet. He worked as a motor mechanic; there was no history of trauma to the chest. He was I69 cm tall and weighed 63-5 kg. There were no physical abnormalities on examination; the blood pressure was I20/70 mmHg, with no evidence of pre-existing hypertension. The peripheral pulses were normally palpable. Electrocardiograms showed the evolution of partialthickness anterolateral cardiac infarction: on the day after admission there were inverted T waves in leads I, aVL, V5, and V6, and ST depression in V4 (Fig. I). Urinalysis, full blood count (Hb I6-3 g/Ioo ml), erythrocyte sedimentation rate, blood urea, electrolytes and proteins, and chest x-ray were all normal. The serum enzymes are shown in Table i. Treatment included analgesics, rest, intravenous heparin and oral warfarin, and he stopped smoking. Over the next two weeks the abnormalities on the electrocardiogram improved, though T inversion in leads I and aVL was still present after 8 weeks. He recovered rapidly and I 11 III aVR aVL aVF