Myocardial infarction with non-obstructive coronary arteries, clinical case

Abstract

Background. Myocardial infarction with non-obstructive coronary arteries (MINOCA) accounts for 5-10% of myocardial infarctions and it is more common in women and younger people. MINOCA has a heterogeneous etiology, but in 8-25% of cases remains unidentifiable despite optimal diagnostic investigations. Objective(s). of the study. Presentation of the clinical case of a young patient with acute coronary syndrome and without known major cardiovascular risk factors, who was subsequently diagnosed with MINOCA. Materials and methods. A 50-year-old woman, non-smoker, with no history of cardiovascular disease, presented to the emergency room of the MCH „Holy Trinity” with constrictive retrosternal pain, radiating to the neck, after an emotional stress. The patient was investigated by blood count, biochemical analyses, troponin I, CK-MB, ECG, echocardiography, coronarography. Results. BP 175/95 mmHg, HR 82 b/min. ECG: sinus rhythm, HR 85 b/min, ST segment depression in the antero-apical region of the LV myocardium. Laboratory data: hemoglobin 137 g/l, creatinine 58 µmol/l, glucose 5 mmol/l, total cholesterol 5.5 mmol/l, LDL-C 3 mmol/l, Tn-I 0.05/15 ng/ml, CK-MB 104 U/l, D-dimers 0.3 mg/l, NT-proBNP 150 pg/ml. Echocardiography: hypokinesia of the LV apex, EF 54%. Coronary angiography: monovascular lesion – acute thrombosis on LAD III, which confirms MINOCA. Treatment with coronary angioplasty, beta-blockers, antiplatelets, ARBs, statins, and investigations for thrombophilia and antiphospholipid syndrome were recommended. Conclusion(s). This case proves that the diagnosis and treatment of MINOCA should receive attention of clinicians, taking into account the young age of onset and the heterogeneity of this syndrome, and the identification of the substrate of thrombosis would contribute to the prevention of a possible future event.