MINOCA-induced apical ballooning case report: a diagnostic conundrum

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.