Abstract
Myocardial infarction without obstructive coronary artery disease (MINOCA) is a common
condition with estimated prevalence of 5 to 15 %. It is not a benign condition and
diagnosing the exact underlying etiology can be challenging, but it is important to
ensure appropriate management of MINOCA patients. Cardiac magnetic resonance imaging
(CMRI) can be a valuable and non-invasive test to identify the underlying etiology,
as well as to risk-stratify such patients. Both the European Society of Cardiology
and the American Heart Association recommend CMRI in diagnostic work up of MINOCA
patients. We report a case of an 83-year-old man who presented to the emergency department
with atypical chest pain but had significantly elevated cardiac troponin levels, with
non-obstructive coronary artery disease on left heart catheterization. Subsequent
CMRI led to the diagnosis of acute myocarditis. He was medically managed with good
clinical outcomes. We discuss this case in detail and highlight the role of CMRI in
MINOCA patients. As our understanding of troponin elevation and its various mechanisms
continues to evolve, cardiac MRI has a significant role in diagnosis and management,
as demonstrated in our case.
Learning objectives
- 1.Illustrate the clinical relevance and diagnosis of myocardial infarction without obstructive coronary artery disease (MINOCA).
- 2.Explain the role of cardiac magnetic resonance imaging in diagnosis and management of MINOCA.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Cardiology CasesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Contemporary diagnosis and management of patients with myocardial infarction in the absence of obstructive coronary artery disease: a scientific statement from the American Heart Association.Circulation. 2019; 139: E891-E908
- Troponin-positive chest pain with unobstructed coronary arteries: incremental diagnostic value of cardiovascular magnetic resonance imaging.Eur Heart J Cardiovasc Imaging. 2016; 17 (Available from): 1146-1152
- Prognostic role of CMR and conventional risk factors in myocardial infarction with nonobstructed coronary arteries.JACC Cardiovasc Imaging. 2019; 12: 1973-1982
- 2020 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation.Eur Heart J. 2021; 42: 1229-1231
- Systematic review of patients presenting with suspected myocardial infarction and nonobstructive coronary arteries.Circulation. 2015; 131 (PMID: 25587100): 861-870https://doi.org/10.1161/CIRCULATIONAHA.114.011201
- Mechanisms of myocardial infarction in women without angiographically obstructive coronary artery disease.Circulation. 2011; 124 (Available from): 1414-1425
- Delayed enhancement and T2-weighted cardiovascular magnetic resonance imaging differentiate acute from chronic myocardial infarction.Circulation. 2004; 109 (Available from): 2411-2416
- Cardiovascular magnetic resonance in myocarditis: A JACC white paper.J Am Coll Cardiol. 2009; 53 (Available from: /pmc/articles/PMC2743893/): 1475-1487
- Cardiovascular magnetic resonance in myocardial infarction with non-obstructive coronary arteries patients: a review.World J Cardiol. 2020; 12 (PMID: 32774777; PMCID: PMC7383353): 248-261https://doi.org/10.4330/wjc.v12.i6.248
Article info
Publication history
Published online: October 13, 2022
Accepted:
August 15,
2022
Received in revised form:
August 8,
2022
Received:
March 22,
2022
Identification
Copyright
© 2022 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved. All rights reserved.
