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Myocardial Infarction with Nonobstructive Coronary Arteries: A Diagnostic Challenge
1National Cardiothoracic Centre, Korle Bu Teaching Hospital, Korle Bu, Accra, Ghana.
Insights
Myocardial infarction with nonobstructive coronary arteries (MINOCA) affects many, particularly younger non-white women. Diagnostic challenges and physician awareness are key issues in managing MINOCA patients.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a frequent cause of cardiovascular morbidity.
- It disproportionately affects non-white women under 55, presenting unique diagnostic challenges.
Observation:
- MINOCA requires further investigation due to diverse pathophysiologic mechanisms.
- Diagnostic hurdles include limited testing modalities, high costs, and specialized expertise.
- Physician awareness is crucial, as MINOCA can be misdiagnosed as functional symptoms.
Findings:
- A case of MINOCA in a patient with atrial fibrillation is presented.
- Diagnostic challenges in evaluating MINOCA are highlighted, emphasizing the need for thorough investigation.
Implications:
- Accurate MINOCA diagnosis is vital to prevent prolonged symptoms and reduce the risk of major adverse cardiovascular events.
- Understanding MINOCA's varied causes is essential for effective empirical treatment, especially in resource-limited settings.
- Increased physician awareness and accessible diagnostic tools are needed to improve MINOCA patient outcomes.
Abstract:
Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a significant cause of cardiovascular morbidity, especially among non-white women younger than 55 years. It is a working diagnosis that warrants further investigation due to its varied underlying pathophysiologic mechanisms. Investigations may be hampered by unavailability of testing modalities, cost, and the expertise to carry out the tests, as they are highly specialized. Clinical history is therefore important, especially in developing countries, to predict potential causes and institute empirical treatment without the luxury of tests. Some physicians are also unaware of this phenomenon and may dismiss symptoms as functional when a coronary angiogram shows nonobstructed coronary arteries, potentially resulting in patients suffering symptoms for longer and incurring extra cost. Most importantly, it leaves them at risk of major adverse cardiovascular events. This article presents a patient with atrial fibrillation who was diagnosed with MINOCA and highlights the diagnostic challenges in evaluating MINOCA.
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