Persistent Ectopy Unmasking Coronary Artery Disease and Familial Hypercholesterolemia in a 32-Year-Old Woman

Coronary artery disease (CAD) is uncommon in young adults although rising in Southeast Asia. Myocarditis is typically considered in cases where viral symptoms precede cardiac injury. Atypical presentations of CAD, including ventricular arrhythmias, can obscure ischemic pathology and delay diagnosis especially in women compared to men.

Significant coronary stenosis due to familial hypercholesterolemia was discovered through cardiac magnetic resonance imaging, multislice computed tomography coronary angiography, echocardiography, and coronary catheterization to overturn an original diagnosis of postviral myocarditis.

CAD in younger people is associated with traditional risk factors such as smoking, dyslipidemia, diabetes, South East Asian descent, and a family history. The identification of a heterozygous low-density lipoprotein receptor mutation confirmed (familial hypercholesterolemia) in this patient and was a critical contributor to this patient's early-onset CAD.

Persistent arrhythmias should prompt further evaluation, including advanced imaging, to rule out occult CAD. Myocardial scarring seen after a presumed viral illness does not always indicate myocarditis in a young person.