Sixty patients less than 35 years with a first Q wave acute myocardial infarction
were prospectively studied to evaluate their features, risk factors and evidence of
any viral infection. Typical chest pain was present in 98.3% with Q waves and ST segment
elevation in all. None had hypotension or cardiogenic shock. Smoking was the most
common risk factor (81.7%). Mean total cholesterol was 5.74 (+/-1.42) mmol/l. History
of a viral illness was present in 28.3%, severe emotional stress in 21.7% and exhausting
physical activity in 18.3%. Mean left ventricular diastolic and end systolic volumes
were increased (90.11+/-22.5 ml/m2) and (46.62+/-20.46 ml/m2), respectively. The ejection
fraction was depressed (49.71+/-1.6%). Triple vessel disease was seen only in 6.8
and 26.7% had insignificant or no coronary artery disease. Left anterior descending
artery was most frequently involved (66%). None had left main involvement. Coronary
ectasia was present in 11.7%, intracoronary thrombus in 28.3% and 40% had collaterals.
Patients with no significant disease had no diabetes, a smaller number had a raised
total cholesterol or smoked and had a lower ejection fraction. Patients from the Indian
subcontinent who had fewer conventional risk factors, had more severe disease than
those from the Arab world suggesting that other etiological factors need investigation.