A Challenging and Unexpected Case of MINOCA Using Multimodality Imaging

Area of Science:

• Cardiology
• Cardiovascular Imaging
• Diagnostic Medicine

Background:

• Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA) presents diagnostic challenges.
• Standard diagnostic pathways may not always identify the underlying cause of MINOCA.
• Right ventricular myocardial infarction is a less common but significant presentation.

Observation:

• A case of MINOCA was investigated, presenting with isolated right ventricular myocardial infarction.
• Cardiac magnetic resonance imaging (CMR) was utilized for detailed cardiac assessment.
• The patient's initial comprehensive, guideline-based assessment did not reveal the specific pathology.

Findings:

• Cardiac MRI successfully identified microvascular obstruction as the cause of myocardial infarction.
• The findings indicate isolated right ventricular involvement.
• This highlights a specific scenario where standard assessments may be insufficient.

Implications:

• This case underscores the importance of advanced imaging like CMR in diagnosing MINOCA.
• It suggests that microvascular dysfunction should be considered even with initial negative findings.
• Further refinement of diagnostic strategies for MINOCA may be warranted.