Left atrial myxoma associated with multivessel coronary embolism confirmed by cardiac magnetic resonance imaging: a case of myocardial infarction with non-obstructive coronary arteries

Abstract

Aims Explore the diagnostic value of multimodal imaging in identifying considerably rare causes of myocardial infarction. Methods and results We report a case of myocardial infarction with non-obstructive coronary arteries (MINOCA) probably due to coronary embolism associated with a left atrial myxoma. A 56-year-old male presented with non-ST-elevation myocardial infarction, with coronary angiography showing mild coronary atherosclerosis without significant epicardial stenosis. Transthoracic echocardiography and cardiac magnetic resonance imaging (CMR) revealed a large left atrial mass, suspected to be an atrial myxoma. CMR also showed an ischaemic pattern involving multiple coronary territories, suggesting coronary embolism as the cause of the MINOCA. The patient underwent successful surgical excision of the left atrial mass, and histopathology confirmed the diagnosis of cardiac myxoma. Conclusions This case highlights the relevance of CMR in detecting ischaemic patterns in patients with a working diagnosis of MINOCA and underlines the diagnostic value of multimodal imaging in identifying considerably rare causes of myocardial infarction, such as myxoma-associated coronary embolism.