Myocardial Infarction With Non-obstructive Coronary Arteries (MINOCA) in a Middle-Aged Male: A Case Report

Myocardial infarction with non-obstructive coronary arteries (MINOCA) represents an uncommon clinical presentation, particularly among male patients with significant comorbidities. This case report describes a 64-year-old male with a complex medical history, including coronary artery disease (CAD), hypertension, chronic kidney disease stage II, heart failure with improved ejection fraction, paroxysmal atrial fibrillation, peripheral arterial disease, obstructive sleep apnea (OSA), and obesity, who presented with non-ST-elevation myocardial infarction (NSTEMI) and positive high-sensitivity troponin titers. Despite angiographic findings revealing no obstructive culprit lesion, cardiac magnetic resonance imaging (MRI) confirmed acute myocardial infarction. Because there was no acutely occluded lesion with angiographic evidence of myocardial infarction, he was diagnosed with MINOCA. Management was adjusted to include dual antiplatelet therapy (DAPT) with clopidogrel and anticoagulation, alongside guideline-directed medical therapy for heart failure. After initiation of therapy for heart failure and acute coronary syndrome (ACS), he remained stable until discharge, with plans for outpatient follow-up to monitor myocardial recovery and further management of comorbidities. This case highlights a common diagnosis in an uncommon population, underscoring the need for advanced imaging to better characterize this patient population.