21岁女性“心衰+心梗”，医生：这个病在年轻人中极易被忽视！

TL;DR - A WeChat clinical case report (医学界) of a 21-year-old woman presenting with decompensated heart failure who was found to have an old right coronary artery infarct and symptomatic triple-vessel disease; it argues clinicians systematically overlook premature coronary artery disease (PCAD) in young patients. Note: the item contains no AI/ML content, so its relevance to an AI digest is limited to being medical-domain source material.

• Presentation: exertional dyspnea and lower-limb edema, BP 168/118 mmHg, HR 110, JVD; troponin mildly elevated (0.043 ng/mL), BNP 1499 pg/mL, HDL low at 22 mg/dL; ECG showed no acute ischemic change while chest X-ray showed pulmonary edema, bilateral effusions, cardiomegaly.
• Workup trajectory: EF fell from 55–60% to 40–45% with global hypokinesis; cardiac MRI showed subendocardial late gadolinium enhancement consistent with old RCA infarct; nuclear stress testing showed a fixed inferior perfusion defect; catheterization revealed LCx 60/80/90% stenoses, LAD 70–90%, and total proximal RCA occlusion with collaterals.
• Risk factors cited: HFpEF history, poorly controlled diabetes, hypertension, nephrotic syndrome, dyslipidemia; the piece defines PCAD as atherosclerotic obstruction before age 45 (men) / 55 (women), notes ~3% of cases are symptomatic under 40, and cites autopsy data (20% of men, 8% of women aged 30–34 with advanced disease).
• Management and message: family declined CABG, so treatment was medical (DAPT, beta-blocker, statin, vasodilators) with outpatient follow-up; the authors urge ischemic workup in young patients whenever cardiac function changes materially, plus tighter control of modifiable risk factors and screening in high-risk youth.