— Joyce, California There are many reasons why a 22-year-old could have chest pain. And while it’s quite rare, a heart attack can occur in a person in his twenties. You may remember the popular Russian Olympic pairs figure skater Sergei Grinkov, who died of a heart attack in 1995 at age 28 while practicing for a performance. His only symptom was back pain and yet an autopsy revealed that he had severely clogged coronary arteries. Further DNA testing showed that he had a rare genetic risk factor linked with premature heart disease. (Grinkov’s father died of a heart attack at age 52.) He was in great shape at the time he died and had none of the typical risk factors associated with heart disease, such as elevated cholesterol or triglyceride levels, high blood pressure, diabetes, or being sedentary. Besides family history and the other risk factors mentioned above, potential causes of heart disease and heart attack in a young person could include a congenital heart abnormality or an unusual problem with blood clotting. By far the most common risk factor in young heart attack patients, as compared to older patients, is smoking. Because smoking tends to promote blood clots, it can cause a heart attack even in those without extensive underlying atherosclerotic plaques. Bear in mind, however, that chest pain is not always caused by a heart problem. For example, conditions like acid reflux (GERD, or gastrointestinal reflux disease), irritation of the diaphragm (the muscle below the chest that allows us to breathe), and certain viral or bacterial infections can also produce this discomfort. Indeed, almost everyone experiences some kind of chest discomfort or shortness of breath from time to time. But if a patient of any age tells me that he or she is suddenly panting or experiencing unusual chest pain while doing a regular workout on a treadmill or while running to catch a plane, for example (in other words, the person’s regular exercise capacity has definitely decreased), I become concerned and will likely do an exercise stress test to see what’s going on. This test helps me figure out whether the symptoms are coming from sluggish blood flow due to a blockage in one or more of the coronary arteries. A stress test is just one of several tests a doctor can perform to rule out heart disease. The physician can also do an electrocardiogram (EKG or ECG) — a simple, noninvasive, completely painless test that takes just minutes — and look for changes on the tracings that indicate compromised blood flow to the heart. Furthermore, when the heart is injured from the inadequate blood flow that causes a heart attack, enzymes leak from the affected tissue and can be measured by a simple blood test. The bottom line: While it’s unlikely that chest pain in a 22-year-old is due to or will result in a heart attack, it is best not to take any chances and to consult a physician. Don’t self-diagnose! Learn more in the Everyday Health Heart Health Center.
