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[Chest pain after angiography without anomalies]

Tim Schutte1,2, Shanti Ramawadhdoebe3, Jeroen Schotten3

  • 1Zaans Medisch Centrum, afd. Interne Geneeskunde, Longgeneeskunde en Cardiologie, Zaandam.

Nederlands Tijdschrift Voor Geneeskunde
|March 16, 2019
PubMed

Insights

Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA) patients face increased future heart disease risks. A case highlights coronary dissection as a potential cause in MINOCA.

Area of Science:

  • Cardiology
  • Internal Medicine

Background:

  • Myocardial infarction is classified by ECG findings (STEMI/NSTEMI) or coronary angiography (CAG).
  • Myocardial Infarction with Non-Obstructive Coronary Arteries/Atherosclerosis (MINOCA) affects up to 25% of myocardial infarction patients.
  • MINOCA patients exhibit a higher risk of future cardiovascular events.

Observation:

  • A 55-year-old woman experienced two myocardial infarctions within a week.
  • The initial event was diagnosed as MINOCA, with normal ECG and CAG.
  • The second event, five days later, presented with ST-elevations on ECG and revealed coronary dissection on CAG.

Findings:

  • This case illustrates a MINOCA diagnosis followed by ST-elevation myocardial infarction due to coronary dissection.
  • Coronary dissection can manifest as a cause of myocardial infarction, even in cases initially presenting as MINOCA.

Implications:

  • MINOCA patients have an elevated risk for recurrent cardiac events.
  • Coronary dissection should be considered in the differential diagnosis of MINOCA, particularly with recurrent symptoms.
  • Further investigation into the mechanisms and management of MINOCA, including dissection, is warranted.
Abstract

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