“I’m having chest pain.”
It’s a declaration guaranteed to grab a physician’s attention. And it certainly got mine one day as my healthy-looking new patient pointed to the middle of his sternum and added, “It’s an ache right here.”
Walk into any emergency room, your fist clutched to your chest, and say, “I’m having chest pain,” and most of the following will happen: You will be fast-tracked to an exam room and connected to a cardiac monitor. Oxygen tubing will be slipped under your nose. An intravenous line delivering saline will be inserted into your forearm. It will be assumed that you are having cardiac pain until proven otherwise. Blood will be drawn and sent stat to the lab. And you will probably be asked to chew an aspirin as a technician performs an electrocardiogram, or EKG, a record of your heart’s electrical activity. It’s a scenario that unfolds hundreds of times a day all over the U.S.
But that’s not how it played out that day in my internal medicine office when my patient, Ryan, pointed to his chest. For starters, he was only 16 years old. Teenagers, even kids, can have coronary artery disease (CAD). But angina and heart attacks this young are rare.
Still, some conditions can lead to hardening of the arteries in children and adolescents. Rare inherited disorders that affect lipid metabolism and cause high cholesterol, for example, can set young people up for CAD. Childhood diabetes, too, may lead to early CAD, especially if there is accompanying obesity. And children with advanced kidney disease, particularly those on dialysis, can develop CAD.
