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From Nonobstructive Plaque to LAD Thrombosis in a 26-Year-Old Athlete
Mohammad Abu Zalam1, Zeyad Kholeif1, Usama Afzaal1
1Baptist Hospitals of Southeast Texas, Beaumont, Texas, USA.
Background:
Stimulants and anabolic steroids have a role in plaque disruption resulting in acute coronary syndrome in young adults.
Case Summary:
A 26-year-old bodybuilder with heavy use of anabolic steroids and energy drinks presented with chest pain and ST-segment changes. Coronary angiography revealed minimal nonobstructive plaque in the proximal left anterior descending artery and left ventricular systolic dysfunction. He was started on guideline-directed medical therapy and counseled to discontinue toxic exposures. Weeks later, he presented with recurrent chest pain and was found to have an acute thrombotic occlusion of the mid-left anterior descending artery requiring urgent revascularization and a drug-eluting stent placement.
Discussion:
This case highlights how synergistic stimulant and anabolic exposure can create dynamic coronary pathology and contribute to endothelial injury, hypercoagulability, and accelerated atherosclerosis.
Take-Home Messages:
Nonobstructive coronary findings do not exclude imminent coronary thrombosis in high-risk young adults. Risk factor cessation and close follow-up are essential.
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Atherosclerosis I: Introduction
Peripheral Artery Disease I: Introduction
Venous Thrombosis I: Introduction
Coronary Artery Disease II: Pathophysiology
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Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations

