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.
