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Ask Dr. Jake: Can I Have a Heart Attack in My Thirties?

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Introducing Jake Deutsch, M.D., a veteran ER doctor and new contributor to The Daily Details. Send your health questions to us in the comments field below (or via Facebook or Twitter). We'll publish answers to some of your queries here every Friday.

The first time I saw a very young patient suffering from a heart attack, he was 27—and so was I. Fresh out of my residency, I took one look at his abnormal EKG and it was glaringly obvious that this guy clenching his chest was legit.

In my 10 years practicing emergency medicine I've seen plenty of young people with chest pains they think are "the big one." Fortunately, very few pan out to be serious. More often than not it's something like acid reflux masquerading as cardiac pain or a false alarm triggered by stress and anxiety. (The last time it was a tattoo artist, who informed me that he had "the most stressful job in the world.") This is all to say that when a real one comes along, and the patient happens to be a mere thirtysomething, it makes you wonder if there is an age at which you need to start worrying about things like your ticker.

A heart attack is the result of a lack of oxygen to the heart muscles and subsequent tissue death. Technically, no one is too young to have a heart attack, it's just that those under 40 don't typically suffer from the diseases that cause them. That said, there are three categories of young people at risk for a coronary before they hit middle age.

1. The toughest cases are those with rare, irreversible medical conditions. These young people have a condition such as an arrhythmia (also known as irregular heart beat) or a heart clot that cannot be prevented. Since these are unforeseeable, worrying about them is just not productive.

2. Then there are heart attacks of the River Phoenix and Anna Nicole Smith variety. It should go without saying that cocaine and drug abuse wreak havoc on the blood vessels to the heart. Massive amounts of toxins can result in a spasm that induces an attack and checks you out of the Chateau Marmont in a body bag.

3. The third and easily preventable type of heart attack is due to accelerated hardening of the arteries, which occurs as the result of Familial Hypercholesterolemia, a condition found in one out of every 500 people.

Here's where you should pay attention: Excessively high "bad" cholesterol accelerates the narrowing of arteries and the potential for a heart attack. How do you know if you're at risk? A simple blood test. Getting your cholesterol checked is critical, especially if you have a family history of heart attacks under 50. If your numbers are high your doctor should consider aggressive treatment with cholesterol-lowering medications, even for those in their thirties. Sadly, most people who are at risk don't know until it's too late and some damage has already been done.

Should you spend your precious fourth decade of life worrying about a heart attack? Certainly not. More 30-year-olds will die from accidental self-inflicted injuries. But if you spend time hitting the gym and trying to eat right, take a moment to have your cholesterol checked. I'd rather not make your acquaintance by diagnosing a freakishly premature heart attack.

—Dr. Jake Deutsch is an New York City-based ER doctor. Follow him @DrJakeDeutsch.

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