The Young Heart Patient

For the most part, cardiology is a geriatric specialty. Heart disease is a process that occurs over decades, and age is one of the strongest risk factors for coronary artery disease. Most of the patients I saw with heart attacks last year and who are getting coronary artery bypass surgery this month are over 60. However, there are a few rare disease states in which young people require heart surgery. Genetic syndromes like Marfan's disease predispose to aortic dissections because the vessel wall weakens over time. I had a young patient who already had her aortic root and aortic valve replaced, but who continued to have a chronic dissection of the aorta and required a revision. It was a very long surgery with over 8 hours on cardiopulmonary bypass, but luckily, the patient's reserve being otherwise healthy and young pulled her through.

Myocardial bridging is one of those newer diagnoses that I have mixed feelings about. In myocardial bridging, the coronary vessels go through the heart muscle rather than on top of it. It's seen in the general population at a reasonable frequency on autopsy, exists at birth, and presents with chest pain. In the past, we didn't have the technology to diagnose it so we didn't do anything about it, but now, we're starting to operate on young adults with symptoms because we can see it on cardiac cath. Patients tend to do fine since it's a small surgery in the world of cardiac interventions, but I wonder if it's overdiagnosed now compared to the past.