Myocardial Infarction with Non-Obstructive Coronary Artery Disease: The Labyrinth of Investigations. Case Report and Review of the Literature
| Autor: | Nicolae-Dan Tesloianu, Iulian Theodor Matei, Ionut Achiței, Antoniu Octavian Petriș, Bogdan Artene, Paul Simion |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Science Infarction Review Culprit General Biochemistry Genetics and Molecular Biology endothelial dysfunction Coronary artery disease STEMI Internal medicine medicine Myocardial infarction Endothelial dysfunction CMR Ecology Evolution Behavior and Systematics MINOCA Ejection fraction business.industry myocardial resistance index Paleontology medicine.disease Coronary arteries medicine.anatomical_structure myocardial infarction Space and Planetary Science Etiology Cardiology business |
| Zdroj: | Life, Vol 11, Iss 1181, p 1181 (2021) Life |
| ISSN: | 2075-1729 |
| Popis: | Myocardial infarction with non-obstructive coronary artery disease (MINOCA) accounts for approximately 5–15% of acute myocardial infarctions (MI). This infarction type raises a series of questions about the underlying mechanism of myocardial damage, the diagnostic pathway, optimal therapy, and the outcomes of these patients when compared to MI associated with obstructive coronary artery disease. We present the case of a 60-year-old patient with multiple cardiovascular risk factors and comorbidities who is admitted in an emergency setting. The patient is known with a conservatively treated inferior myocardial infarction which occurred 3 months prior, with reduced left ventricular ejection fraction. Emergency coronary angiography revealed normal epicardial coronary arteries, which led to further investigations of the underlying cause. Considering the absence of epicardial and microvascular spasm, CMR (cardiac magnetic resonance) confirmation of two transmural myocardial infarctions in the territories tributary to coronary arteries, and a high index of myocardial resistance in culprit arteries, we concluded the diagnosis of MINOCA due to the microvascular endothelial dysfunction. Although the concept of MINOCA was devised almost a decade ago, and these patients are an important part of MI presentations, it still represents a diagnostic challenge with multiple explorations required to establish the precise etiology. |
| Databáze: | OpenAIRE |
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