Dr Narasimha Pai

A 90% blockage in a coronary artery may sound unusual in someone in their early 30s, but young age does not completely protect a person from coronary artery disease. In some cases, significant narrowing can develop without the typical symptoms people associate with heart disease.

Coronary Artery Disease Can Begin Years Before Symptoms

Coronary artery disease develops when fatty deposits, cholesterol and other substances build up inside the walls of the arteries supplying blood to the heart. This process can begin years before symptoms appear. A person may continue with normal daily activities and even exercise regularly while the disease progresses silently.

Not everyone with significant coronary blockage experiences dramatic chest pain. Some may notice only breathlessness while climbing stairs, unusual fatigue, reduced exercise capacity, dizziness or discomfort in the chest, back, jaw or upper abdomen. Others may have no obvious symptoms until the blood supply to the heart is suddenly reduced.

Why Can Blockages Occur So Early?

This is particularly relevant in young adults with risk factors such as diabetes, high blood pressure, high cholesterol, smoking, obesity, a sedentary lifestyle or a strong family history of premature coronary artery disease. Genetic conditions that cause very high cholesterol can also lead to coronary disease at a much younger age.

A 90% Blockage Does Not Always Mean a Heart Attack

A high-grade blockage does not necessarily mean that a heart attack has already occurred. Some people develop gradually progressive narrowing, while others may have a sudden blockage caused by rupture of a cholesterol plaque and formation of a blood clot. The severity and significance of a blockage therefore need to be assessed in the context of symptoms, risk factors and cardiac investigations.

It is also important not to assume that every episode of chest discomfort in a young person is heart disease. Muscle strain, acidity and several other conditions can cause similar symptoms. At the same time, dismissing persistent or unexplained symptoms simply because someone is young can delay diagnosis.

When Should a Young Person Get Checked?

Evaluation may include an ECG, blood tests, echocardiography, exercise testing or coronary imaging, depending on the individual's symptoms and risk profile. Routine testing of every healthy young person is not necessary, but people with significant risk factors or concerning symptoms may need earlier assessment.

The key point is that coronary artery disease is not exclusively a disease of older adults. In a small but important group of young people, it can develop silently and become significant before the person realizes there is a problem. Knowing your blood pressure, cholesterol, blood sugar and family history, avoiding tobacco and seeking medical attention for unexplained changes in exercise tolerance or other symptoms can help identify risk before a major cardiac event occurs.

(Dr Narasimha Pai is HoD and Consultant Cardiology at KMC Hospital, Mangaluru)