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ST Elevation MI with Normal Coronary Arteries: A MINOCA Case
Hilal Olgun Kucuk1, Ugur Kucuk1, Muhammed Hamza Saad Shaukat2
1Department of Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota.
Summary
Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a common cause of heart attacks, especially in young women. Further investigation is crucial as MINOCA outcomes are comparable to traditional heart attacks.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Acute Myocardial Infarction
Background:
- Myocardial infarction with nonobstructive coronary arteries (MINOCA) presents as myocardial infarction despite normal or near-normal coronary arteries on angiography.
- MINOCA is increasingly recognized and affects specific demographics, including younger women and nonwhite individuals.
Observation:
- A case of a 35-year-old female with MINOCA is presented, detailing symptoms, EKG findings, and elevated troponin levels.
- Coronary angiography revealed normal coronary arteries, while echocardiography showed reduced ejection fraction and lateral wall hypokinesis.
- Cardiac magnetic resonance imaging confirmed myocardial scar with transmural late gadolinium enhancement in the lateral wall, indicative of myocardial infarction.
Findings:
- MINOCA is a frequent presentation of acute myocardial infarction (AMI), often seen in younger women and nonwhites.
- Patients with MINOCA typically have fewer traditional cardiovascular risk factors and may present with non-ST-segment elevation myocardial infarction.
- Diagnostic imaging, including CMR, is essential for identifying myocardial scar and confirming infarction in MINOCA.
Implications:
- MINOCA is not a benign condition, with outcomes comparable to AMI with coronary artery disease (CAD), particularly in younger patients.
- Identifying the underlying etiology of MINOCA is critical for guiding appropriate treatment strategies.
- Further research into MINOCA pathogenesis and management is warranted to improve patient outcomes.
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