Triple Total Coronary Occlusions in a Young Adult: Looking Beyond Conventional Atherosclerotic Risk Factors

Severe coronary artery disease is uncommon in young adults, particularly when conventional cardiovascular risk factors are limited.We describe a 26-year-old man who presented with exertional chest pain and was found to have total occlusions affecting all three major coronary arteries.Extensive investigation for inherited, metabolic, autoimmune, and inflammatory causes did not identify a definitive aetiology.His history of heavy electronic-cigarette use and a prolonged febrile illness in childhood were considered potentially relevant but could not be established as causal.He ultimately underwent successful three-vessel coronary artery bypass grafting.This case highlights the importance of investigating unusual causes of severe premature coronary disease while avoiding over-attribution to unconfirmed risk factors.