ST-elevation myocardial infarction in the setting of non-obstructive coronaries

Myocardial infarction with non-obstructive coronary artery (MINOCA) accounts for 5-6% of all acute coronary syndrome presentations. Common causes of MINOCA include coronary vasospasm, coronary embolism/thrombosis, myocarditis, and spontaneous coronary artery dissection. Of them all, myocarditis is the most common cause of MINOCA, accounting for up-to 33% of all MINOCA cases. Our case is a 36-year-old female that presented with chest pain. Her electrocardiogram was concerning for myocardial infarction. However, coronary angiography revealed non-obstructive coronaries hence MINOCA. Cardiac magnetic resonance confirmed the underlying etiology of MINOCA as myocarditis. The patient was treated with risk factor modifications, heart failure therapy, and anti-inflammatories for her myocarditis. Follow up with cardiology noted improvement in her ejection fraction and symptoms. <Learning objective: Myocarditis is responsible for a significant portion of the cases of myocardial infarction with non-obstructive coronary artery. Therefore, it is important for clinicians to promptly recognize, diagnose, and treat it effectively to prevent future complications, and avoid unnecessary medical testing. In young patients, with low likelihood for acute coronary syndrome, cardiac magnetic resonance should be utilized to confirm the diagnosis of myocarditis.>.