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A Hidden Culprit Illuminated with Advanced Cardiac Imaging
Hampton A Crimm1, Benjamin W Little1, Eugene K Soh1
1Cardiology Service, Department of Medicine, Walter Reed National Military Medical Center, 8930 Brown Drive, Building 9A, 2nd Floor, Bethesda, MD 20889.
Military Medicine
|February 8, 2018
Summary
Multimodality cardiac imaging aids in diagnosing myocardial infarction with nonobstructive coronary artery disease. Combining cardiac MRI, OCT, and angiography confirmed complex coronary artery disease when initial tests were inconclusive.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Myocardial infarction (MI) with nonobstructive coronary artery disease (MINOCA) presents diagnostic challenges.
- Identifying the specific cause of MINOCA is crucial for appropriate patient management.
Observation:
- A case is presented where initial coronary catheterization did not reveal a culprit lesion.
- The patient presented with symptoms suggestive of myocardial infarction.
Findings:
- Multimodality cardiac imaging, including cardiac magnetic resonance imaging (CMR), optical coherence tomography (OCT), and invasive coronary angiography, was employed.
- The combined imaging approach successfully identified unstable, complex coronary artery disease.
Implications:
- This case highlights the synergistic value of integrating various cardiac imaging modalities.
- Accurate diagnosis of MINOCA can be achieved through a comprehensive imaging strategy, even without an obvious lesion on initial angiography.
- This approach can lead to more precise treatment strategies for patients with complex coronary artery disease.
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