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MINOCA-induced apical ballooning case report: a diagnostic conundrum.

Moez Dungarwalla1, Polyvios Demetriades1, Martin Been1

  • 1University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK.

European Heart Journal. Case Reports
|August 11, 2021
PubMed
Summary

Myocardial infarction with non-obstructive coronary arteries (MINOCA) can mimic Takotsubo cardiomyopathy (TTC). MINOCA can cause structural defects like ventricular septal defects, requiring advanced imaging for diagnosis and treatment planning.

Keywords:
Cardiovascular magnetic resonanceCase reportsMINOCAMyocardial infarction with non-obstructive coronary arteriesTakotsubo cardiomyopathyVentricular septal defect

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Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Interventional Cardiology

Background:

  • Myocardial infarction with non-obstructive coronary arteries (MINOCA) presents without flow-limiting lesions, mimicking other cardiac conditions.
  • MINOCA can lead to structural cardiac defects due to ischemic injury.
  • Distinguishing MINOCA from Takotsubo cardiomyopathy (TTC) is crucial due to different treatment strategies.

Observation:

  • A case is presented of a patient initially suspected of TTC, but ultimately diagnosed with MINOCA.
  • The MINOCA induced an apical ventricular septal defect (VSD).
  • Diagnosing MINOCA was challenging due to the lack of a definitive diagnostic standard.

Findings:

  • Advanced imaging techniques were essential for diagnosing MINOCA and planning VSD closure.
  • Cardiovascular magnetic resonance imaging (CMR) was instrumental in identifying the primary MINOCA pathology and guiding structural defect remediation.
  • The presence of structural myocardial defects in suspected TTC cases warrants investigation for underlying MINOCA.

Implications:

  • Accurate diagnosis of MINOCA is critical for appropriate patient management.
  • CMR imaging is valuable for diagnosing MINOCA and assessing associated structural defects.
  • Clinicians should consider MINOCA in patients presenting with TTC-like symptoms and structural cardiac abnormalities.