Myocardial Infarction with Non-Obstructive Coronary Artery Disease: The Labyrinth of Investigations. Case Report and Review of the Literature

Myocardial infarction with non-obstructive coronary artery disease (MINOCA) accounts for approximately 5–15% of acute myocardial infarctions (MI). This infarction type raises a series of questions about the underlying mechanism of myocardial damage, the diagnostic pathway, optimal therapy, and the o...

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Autores principales:	Paul Simion, Bogdan Artene, Ionut Achiței, Iulian Theodor Matei, Antoniu Octavian Petriș, Nicolae-Dan Tesloianu
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	MINOCA myocardial infarction STEMI myocardial resistance index endothelial dysfunction CMR Science Q
Acceso en línea:	https://doaj.org/article/c1794f9fc03e4186b424851f9d2e5b56
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spelling	oai:doaj.org-article:c1794f9fc03e4186b424851f9d2e5b562021-11-25T18:10:57ZMyocardial Infarction with Non-Obstructive Coronary Artery Disease: The Labyrinth of Investigations. Case Report and Review of the Literature10.3390/life111111812075-1729https://doaj.org/article/c1794f9fc03e4186b424851f9d2e5b562021-11-01T00:00:00Zhttps://www.mdpi.com/2075-1729/11/11/1181https://doaj.org/toc/2075-1729Myocardial infarction with non-obstructive coronary artery disease (MINOCA) accounts for approximately 5–15% of acute myocardial infarctions (MI). This infarction type raises a series of questions about the underlying mechanism of myocardial damage, the diagnostic pathway, optimal therapy, and the outcomes of these patients when compared to MI associated with obstructive coronary artery disease. We present the case of a 60-year-old patient with multiple cardiovascular risk factors and comorbidities who is admitted in an emergency setting. The patient is known with a conservatively treated inferior myocardial infarction which occurred 3 months prior, with reduced left ventricular ejection fraction. Emergency coronary angiography revealed normal epicardial coronary arteries, which led to further investigations of the underlying cause. Considering the absence of epicardial and microvascular spasm, CMR (cardiac magnetic resonance) confirmation of two transmural myocardial infarctions in the territories tributary to coronary arteries, and a high index of myocardial resistance in culprit arteries, we concluded the diagnosis of MINOCA due to the microvascular endothelial dysfunction. Although the concept of MINOCA was devised almost a decade ago, and these patients are an important part of MI presentations, it still represents a diagnostic challenge with multiple explorations required to establish the precise etiology.Paul SimionBogdan ArteneIonut AchițeiIulian Theodor MateiAntoniu Octavian PetrișNicolae-Dan TesloianuMDPI AGarticleMINOCAmyocardial infarctionSTEMImyocardial resistance indexendothelial dysfunctionCMRScienceQENLife, Vol 11, Iss 1181, p 1181 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	MINOCA myocardial infarction STEMI myocardial resistance index endothelial dysfunction CMR Science Q
spellingShingle	MINOCA myocardial infarction STEMI myocardial resistance index endothelial dysfunction CMR Science Q Paul Simion Bogdan Artene Ionut Achiței Iulian Theodor Matei Antoniu Octavian Petriș Nicolae-Dan Tesloianu Myocardial Infarction with Non-Obstructive Coronary Artery Disease: The Labyrinth of Investigations. Case Report and Review of the Literature
description	Myocardial infarction with non-obstructive coronary artery disease (MINOCA) accounts for approximately 5–15% of acute myocardial infarctions (MI). This infarction type raises a series of questions about the underlying mechanism of myocardial damage, the diagnostic pathway, optimal therapy, and the outcomes of these patients when compared to MI associated with obstructive coronary artery disease. We present the case of a 60-year-old patient with multiple cardiovascular risk factors and comorbidities who is admitted in an emergency setting. The patient is known with a conservatively treated inferior myocardial infarction which occurred 3 months prior, with reduced left ventricular ejection fraction. Emergency coronary angiography revealed normal epicardial coronary arteries, which led to further investigations of the underlying cause. Considering the absence of epicardial and microvascular spasm, CMR (cardiac magnetic resonance) confirmation of two transmural myocardial infarctions in the territories tributary to coronary arteries, and a high index of myocardial resistance in culprit arteries, we concluded the diagnosis of MINOCA due to the microvascular endothelial dysfunction. Although the concept of MINOCA was devised almost a decade ago, and these patients are an important part of MI presentations, it still represents a diagnostic challenge with multiple explorations required to establish the precise etiology.
format	article
author	Paul Simion Bogdan Artene Ionut Achiței Iulian Theodor Matei Antoniu Octavian Petriș Nicolae-Dan Tesloianu
author_facet	Paul Simion Bogdan Artene Ionut Achiței Iulian Theodor Matei Antoniu Octavian Petriș Nicolae-Dan Tesloianu
author_sort	Paul Simion
title	Myocardial Infarction with Non-Obstructive Coronary Artery Disease: The Labyrinth of Investigations. Case Report and Review of the Literature
title_short	Myocardial Infarction with Non-Obstructive Coronary Artery Disease: The Labyrinth of Investigations. Case Report and Review of the Literature
title_full	Myocardial Infarction with Non-Obstructive Coronary Artery Disease: The Labyrinth of Investigations. Case Report and Review of the Literature
title_fullStr	Myocardial Infarction with Non-Obstructive Coronary Artery Disease: The Labyrinth of Investigations. Case Report and Review of the Literature
title_full_unstemmed	Myocardial Infarction with Non-Obstructive Coronary Artery Disease: The Labyrinth of Investigations. Case Report and Review of the Literature
title_sort	myocardial infarction with non-obstructive coronary artery disease: the labyrinth of investigations. case report and review of the literature
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/c1794f9fc03e4186b424851f9d2e5b56
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Myocardial Infarction with Non-Obstructive Coronary Artery Disease: The Labyrinth of Investigations. Case Report and Review of the Literature

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