There may be a less than 2% chance of cardiovascular event over 10 years in healthy people under 40, compared with more than 20% in those over 65 with risk factors. We scrutinize every case so we can catch that small percentage of young people with heart disease.
When someone 35 or younger complains of symptoms concerning for heart disease, such as palpitations, shortness of breath or chest pains, we see them at the new Norton Heart & Vascular Institute Young Adult Cardiology Clinic, located on the campus of Norton Brownsboro Hospital.
More and more young people come to us anxious about their hearts. Although statistically we know most of them don’t have heart disease, we still take their complaints seriously. Heart disease is on the rise in the younger population, with more and more heart attack patients presenting at a younger age.
We also know we shouldn’t approach a 25-year-old with chest pain the same way as a 55-year-old with chest pain. With that in mind, seeing young adults in a special clinic makes the most sense, rather than mixing them in with older patients at a traditional cardiology clinic.
A place where they’ll be taken seriously
Our Young Adult Cardiology Clinic allows these patients an avenue to have their concerns addressed without embarrassment. Frequently, these patients will tell me, “I don’t want to waste your time.” It’s never a waste of time if you have a symptom that concerns you. Getting an evaluation is the right thing to do.
We want to take everybody’s complaint seriously, no matter their age. Usually, we can rule out heart disease pretty quickly, sometimes with just history and physical exam, and other times some degree of testing will be necessary. This can alleviate the patient’s anxiety and that of the referring provider.
Of course, it’s not impossible to have heart disease at a young age. It’s just a lot less likely. There may be a less than 2% chance of cardiovascular event over 10 years in healthy people under 40, compared with more than 20% in those over 65 with risk factors. We scrutinize every case so we can catch that small percentage of young people who have heart disease.
Finding that small percentage of young people with a dangerous condition
Seeing this population of patients exclusively at the Young Adult Cardiology Clinic, we’re focused on looking for very specific indications of possible heart disease in a young person.
Our goal is to ask the right questions and perform the appropriate tests. We do not want to over-test. We may not need to do any testing at all. There are times we simply need to listen to their story to realize the patient is good to go home. For example, chest pain in a young person frequently will be pleurisy or muscle pain.
With chest pain, age is the biggest stratifier for risk. Weight, diet and exercise also play a role. A patient who is 32 and has all these lifestyle-related risk factors could have blockages in spite of their age. We’ve had people come in with heart failure in their late 20s and early 30s. The sensation of heart palpitations can indicate anything from a life-threatening rhythm to a normal heart rhythm. With an electrocardiogram (EKG), we can see if there are high-risk features.
We tend to think no one at a young age has heart disease, but there is a small percentage who do, and they need to be treated as early as possible. One patient came in recently complaining of heart palpitations. He had more than 20,000 premature ventricular contractions (PVCs) on the Holter monitor, which is very frequent and put him at risk for cardiomyopathy. Another had congestive heart failure in his early 30s. Cases like these are important reminders that you have to screen all patients with complaints so as not to miss the rare young person facing a dangerous heart condition.
Mostafa O. El-Refai, M.D., M.S., MBA, is an interventional cardiologist with Norton Heart & Vascular Institute.