Triple Vessel Coronary Artery Disease Identified in a 21-Year-Old Female.

Premature coronary artery disease (CAD) is characterized by the presence of symptomatic atherosclerosis in the coronary circulation in males below the age of 55 and females below the age of 45. We present the case of a 21-year-old female with a past medical history of heart failure with preserved ejection fraction, poorly controlled diabetes mellitus, essential hypertension, nephrotic syndrome, dyslipidemia, and class I obesity who presented with complaints of worsening bilateral lower extremity edema and exertional shortness of breath. Given her physical examination findings and laboratory investigations, a diagnosis of heart failure exacerbation was made. Echocardiography revealed a significant change in ejection fraction from three months earlier, and thus, she underwent a nuclear stress test. She was found to have fixed perfusion defects in the inferior wall. A diagnostic left heart catheterization identified severe triple vessel disease affecting the left anterior descending, left circumflex, and right coronary arteries. The patient and her family opted against coronary artery bypass grafting, and she was discharged to pursue high-risk intervention as an outpatient. This case highlights the importance of strict regulation of modifiable risk factors for CAD even in teenagers and young adults as her disease process likely began several years prior to the ultimate development of triple vessel CAD.