Related Experiment Video
Updated: May 10, 2025
Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Unveiling the invisible culprit: a multimodality approach for myocardial infarction with non-obstructive coronary
Riccardo Terzi1, Pasquale Paolisso1, Francesca Di Lenarda1
1Division of University Cardiology, IRCCS Ospedale Galeazzi Sant'Ambrogio, Via Cristina Belgioioso 173, 20157 Milan, Italy.
Background:
Myocardial infarction with non-obstructive coronary arteries (MINOCA) affects up to 10% of patients undergoing coronary angiography for acute myocardial infarction. Despite the lack of obstructive lesions, these patients face significant risks, requiring thorough diagnostic evaluations, often using both invasive and non-invasive methods. Recent guidelines emphasize the importance of performing intravascular imaging, coronary functional testing (CFT), and cardiac magnetic resonance (CMR) in the working diagnosis of MINOCA.
Case Summary:
A 48-year-old woman presented with chest pain, elevated cardiac troponins, and signs of non-ST-elevation myocardial infarction. Echocardiography showed normal left ventricular ejection fraction with focal inferior-lateral mid-apical hypokinesia and no significant valvular heart disease. Coronary angiography revealed normal arteries with hypoplasia of the right coronary artery. Further testing, including CMR and CFT with acetylcholine provocation, confirmed severe coronary spasm, diagnosing epicardial vasospastic angina causing MINOCA.
Discussion:
Diagnosing MINOCA is challenging and requires a multimodal approach. Invasive testing can reveal vasospasm or microvascular dysfunction. This case emphasizes the need for repeated imaging and functional tests to reach a diagnosis. Calcium channel blockers like diltiazem are commonly used in treatment.
