Premature Multivessel Coronary Artery Disease in a 31-Year-Old Woman With Ischemic Cardiomyopathy, Left Ventricular Thrombus, Stroke, and End-Stage Renal Disease

Ischemic cardiomyopathy and multivessel coronary artery disease (CAD) are uncommon in young adults, particularly women younger than 35 years, and are often associated with atypical or aggressive risk factors. The coexistence of severe left ventricular (LV) systolic dysfunction and LV thrombus further increases morbidity because of heightened embolic risk. We present the case of a 31-year-old woman with poorly controlled type 2 diabetes mellitus, hypertension, and chronic kidney disease who presented with dyspnea and edema and was found to have a non-ST-elevation myocardial infarction (NSTEMI). Evaluation revealed severe multivessel CAD, ischemic cardiomyopathy with a left ventricular ejection fraction (LVEF) of 23%, and a large LV apical thrombus on cardiac magnetic resonance imaging. Her hospital course was complicated by acute ischemic stroke, suspected heparin-induced thrombocytopenia, and newly recognized end-stage renal disease (ESRD). Management required complex anticoagulation decisions and delayed surgical revascularization. After prolonged medical optimization, she successfully underwent coronary artery bypass grafting (CABG). This case highlights the diagnostic and therapeutic challenges of advanced ischemic heart disease with LV thrombus in a young woman and underscores the importance of individualized multidisciplinary care in managing rare but high-risk cardiovascular presentations.