CMR unmasks a right ventricular embolic infarction pattern in MINOCA

Area of Science:

• Cardiology
• Cardiovascular Imaging
• Pathophysiology

Background:

• Myocardial infarction with non-obstructive coronary arteries (MINOCA) presents a diagnostic challenge.
• Etiological clarification of MINOCA often necessitates advanced imaging techniques.
• Distinguishing MINOCA causes is crucial for appropriate patient management.

Purpose of the Study:

• To investigate the etiological basis of MINOCA in a patient initially suspected of myocarditis.
• To demonstrate the utility of cardiovascular magnetic resonance (CMR) in diagnosing MINOCA.
• To highlight the impact of identifying coronary embolism as the underlying mechanism.

Main Methods:

• Cardiovascular magnetic resonance (CMR) imaging was employed for detailed cardiac assessment.
• Clinical history and diagnostic workup were performed to identify potential causes.
• Detection of paroxysmal atrial fibrillation was pursued for etiological clarification.

Main Results:

• CMR revealed right ventricular and inferoseptal embolic myocardial infarction.
• Evidence of microvascular obstruction (MVO) was identified.
• Paroxysmal atrial fibrillation was subsequently detected, supporting coronary embolism.

Conclusions:

• Cardiovascular magnetic resonance (CMR) is effective in diagnosing MINOCA and identifying microvascular obstruction.
• Coronary embolism, secondary to paroxysmal atrial fibrillation, was identified as the cause of MINOCA.
• Accurate etiological diagnosis significantly impacts the management of MINOCA patients.