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Abstract

Myocardial infarction (MI) with no obstructive coronary atherosclerosis (MINOCA) is a syndrome with different causes. Its prevalence ranges between 5 and 25% of all MIs. The prognosis is extremely variable, depending on the causes of MINOCA. Clinical history, echocardiography, coronary angiography, and left ventriculography represent the first-level diagnostic investigations. Nevertheless, additional tests are required in order to establish its specific cause, thus allowing an appropriate risk stratification and treatment. We review pathogenesis, diagnosis, prognosis, and therapy of MINOCA and propose an algorithm for its management.

Acute myocardial infarction, No obstructive coronary atherosclerosis
© Crown copyright 2014.
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Reviews > Clinical update
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Comments (1)
"Re:""Acute myocardial infarction with no obstructive coronary atherosclerosis: mechanisms and management""Niccoli, et al., 36 (8): 475-481 doi:10.1093/eurheartj/ehu469"
29 March 2015
Oscar,M Jolobe, retired geriatrician
Manchester Medical Society
For the sake of completeness Table 1, which lists the differential diagnosis of MINOCA(1), ought to include two other causes of this syndrome:-
(i) Protein C deficiency, documented in a 37 year old man with myocardial infarction attributable to a thrombus in the distal left anterior descending artery and proximal diagonal artery. After thrombosuction a coronary angiogram showed that the coronary arteries were fully patent without any underlying atherosclerosis(2)
(ii) Right ventricular infraction attributable to massive pulmonary embolism. This was documented in a 67 year old woman in whom ischaemic injury to the right ventricle was attributed to increased right ventricular pressure overload and high ventricular wall tension resulting from the high pulmonary artery pressure generated by massive pulmonary embolism. In support of the diagnosis of myocardial infarction plasma cardiac troponin was elevated at 2.5 ng/ml(reference range 0-0.5 ng/ml). Furthermore, despite the fact that coronary angiography showed only insignificant changes in the left anterior descending artery and no morphological abnormalities in the right coronary artery, subsequent heart scintigraphy showed abnormal technetium Tc 99m pyrophosphate uptake within the right ventricle and left ventricular inferior wall indicative of acute myocardial damage. Paradoxical embolism was ruled out by the fact that she did not have a patent foramen ovale(3)
References
(1) Niccoli G., Scalone G., Crea F
Acute myocardial, infarction with no obstructive coronary atherosclerosis: mechanisms and management
Eur HEART J 2015;36:475-481
(2) Maqbool S., Rastogi V., Seth A et al
Protein-C deficiency presenting as pulmonary embolism and myocardial, infarction in the same patient
Thrombosis Journal 2013;11:19
(3) Puszczyk P., Szulc M., Horszczaruk G., Gurba H., Kobylecka M
Right ventricular infarction in a patient with acute pulmonary embolism and normal coronary arteries
Arch Intern Med 2003;163:1110-1111
Submitted on 29/03/2015 8:00 PM GMT