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[Myocardial infarction "with angiographically normal coronary arteries (author's transl)]
Insights
Some myocardial infarction cases with normal coronary arteries may stem from regional myoaggressive myocarditis, challenging traditional diagnoses. This study highlights myocarditis as a potential cause in patients presenting with infarction symptoms but clear coronary arteries.
Area of Science:
- Cardiology
- Pathology
- Diagnostic Imaging
Background:
- Myocardial infarction (MI) is typically associated with coronary artery disease.
- A subset of patients present with MI symptoms and electrocardiographic changes but have normal coronary arteries.
- The etiology of MI in the absence of obstructive coronary disease remains incompletely understood.
Purpose of the Study:
- To investigate the underlying causes of myocardial infarction in patients with normal coronary arteries.
- To explore the role of regional myoaggressive myocarditis as a differential diagnosis.
Main Methods:
- Selective coronary angiography was performed on 121 patients presenting with clinical and electrocardiographic evidence of MI.
- Clinical, hemodynamic, and angiographic data were meticulously analyzed.
- Patients with normal coronary arteries were further evaluated for alternative etiologies.
Main Results:
- Four out of 121 patients (3%) exhibited normal coronary arteries despite MI indicators.
- One patient was diagnosed with regional myoaggressive myocarditis; another showed high probability.
- Two patients remained unclassified, lacking clear coronary or primary myocardial disease diagnosis.
Conclusions:
- Regional myoaggressive myocarditis is a potential cause for myocardial infarction presentation in patients with normal coronary arteries.
- This finding challenges the conventional understanding of MI and suggests a need for broader differential diagnoses.
- Further research is warranted to fully elucidate the mechanisms and prevalence of myocarditis presenting as MI.
Abstract:
Within a cohort of 121 patients with clinical picture and electrocardiographic pattern of myocardial infarction four cases (3%) had normal coronary arteried demonstrated by selective coronary angiography. Two patients revealed no risk factors, two patients were heavy cigarette smokers. Mean age of patients was 34 years. Exact analysis of clinical, hemodynamic and angiographis data confirmed assumption of regional myoaggressive myocarditis as the underlying disease in one patient and suggested regional myocarditis with high probability in another case. The two other patients however could not be classified as having coronary or primary myocardial disease. The investigation suggests that some cases with the clinical and electrocardiographic pattern of "myocardial infarction" with normal coronary arteries may be due to regional myoagressive myocarditis.