Premature myocardial infarction presenting with acute pulmonary embolism: a case report

Introduction: Myocardial infarction and coronary artery disease in people under 40 years of age are relatively uncommon. To establish a diagnosis, physicians need a high degree of clinical suspicion. Case presentation: We report the case of a 33-year-old Caucasian man presenting with classical signs and symptoms of acute pulmonary embolism. Subsequent investigations interestingly revealed right ventricular mural thrombus with no obvious underlying pathology triggering it. On cardiac magnetic resonance imaging, he was found to have a right ventricular infarct with secondary thrombus formation. Coronary angiography confirmed ostial occlusion of the right coronary artery. Conclusion: This is an unusual case of premature myocardial infarction presenting primarily with secondary complications. Introduction Coronary artery disease and myocardial infarction occur more frequently in patients over the age of 40 years. However, they can affect patients younger than 40 years and clinicians need a very high degree of clinical suspicion to establish a diagnosis in this group. In this case report, we illustrate the occurrence of premature myocardial infarction in a 33-year-old man, who presented with symptoms from secondary complications. Case presentation A 33-year-old Caucasian man presented to casualty with sudden onset of severe pleuritic chest pain associated with haemoptysis. He suffered from progressive dyspnoea and had felt generally unwell for a month before this presentation. He had received three courses of antibiotics from his general practitioner for a possible chest infection, to no effect. His past medical history was of Ramstedt’s pylorotomy for congenital pyloric stenosis. He had an 18 pack-year history of smoking and denied any use of recreational drugs. There were no other risk factors for cardiovascular disease. On presentation, he was tachycardic at 120 beats per minute, and tachypnoeic at 36 breaths per minute. Pulse