An 18-year-old male is brought to the ER due to chest pain and shortness of breath for 3 hours. The patient is an athlete by profession. There is no history of diabetes and hypertension. He does not use tobacco or alcohol. His height is 177.8 cm (5ft 10 inch), and his BMI is 19 kg/m2. Blood pressure is 128/86 mm of Hg, and pulse is 80/ min. There is a presence of raised, yellowish, waxy nodules over his wrist and ankles shown in the exhibit. The lungs are clear on auscultation, and there are no heart murmurs. The patient’s mother reports that his father died of a heart attack at 42 years. The patient had done a routine health check-up two days prior, where his lipid profile showed:
Total cholesterol: 713 mg/dl
HDL: 48 mg/dl
LDL: 244 mg/dl
Triglyceride: 121 mg/dl
The thyroid function test is normal. An electrocardiogram is consistent with features of acute anterior wall myocardial infarction.