Background: Familial hypercholesterolaemia is a well-known disorder, but clinical diagnoses tend to be delayed. Acute coronary syndrome may occur in childhood.
Case summary: Our patient, a young boy with homozygous familial hypercholesterolaemia, complained of persistent chest pain at rest and suffered a non-ST-elevation myocardial infarction (NSTEMI). The diagnosis of NSTEMI was made on the basis of his clinical features, dynamic electrocardiogram changes, troponin elevation, and cardiac computed tomography findings. The patient was managed surgically by intrathoracic artery (ITA) bypass graft. During post-operative follow-up, the young patient suffered from angina pectoris from unexpected and exceptional atheroma stenosis on the ITA.
Discussion: Familial hypercholesterolaemia needs to be identified quickly in young patients and lipid lowering therapies should be started without delay.
Keywords: Acute coronary syndrome; Case report; Homozygous familial hypercholesterolaemia; LDL cholesterol.
© The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.