Multimodality Imaging in a Patient With MINOCA and Anomalous Coronary Artery

Area of Science:

• Cardiology
• Diagnostic Imaging
• Medical Case Study

Background:

• Myocardial infarction with nonobstructive coronary arteries (MINOCA) presents a diagnostic challenge due to its heterogeneous nature.
• Accurate diagnosis and management of MINOCA necessitate a multimodal imaging approach.
• Identifying the specific etiology of MINOCA is critical for effective treatment strategies.

Observation:

• A 60-year-old male with hypertension and no prior coronary artery disease experienced angina.
• Initial investigations revealed septal ischemia and an anomalous septal artery with an interarterial course via coronary computed tomography angiography (CCTA).
• A subsequent non-ST-segment elevation myocardial infarction was diagnosed, with cardiac magnetic resonance confirming infarction and prior CCTA suggesting acute occlusion of the anomalous septal artery.

Findings:

• Coronary angiography demonstrated no obstructive coronary artery disease.
• Multimodal imaging, including CCTA and cardiac magnetic resonance, identified an anomalous septal artery as the likely cause of MINOCA.
• The case highlights the importance of evaluating coronary anomalies in MINOCA.

Implications:

• This case emphasizes the crucial role of multimodal imaging in the diagnosis and management of MINOCA.
• Coronary computed tomography angiography and cardiac magnetic resonance are complementary tools for elucidating MINOCA etiologies.
• Recognizing coronary anomalies in MINOCA patients can lead to optimized patient management and improved outcomes.