Myocardial Infarction With Non-obstructive Coronary Arteries: An Updated Overview of Pathophysiology, Diagnosis, and Management

Khan, Arshan; Lahmar, Abdelilah; Riasat, Maria; Ehtesham, Moiz; Asif, Haris; Khan, Warisha; Haseeb, Muhammad; Boricha, Hetal

doi:10.7759/cureus.23602

Cited by 6 publications

(4 citation statements)

References 42 publications

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“…In the literature, intracoronary nitroglycerin is consistently recognized as a vital diagnostic tool during coronary angiography especially when coronary vasospasm is suspected [ 9 , 10 , 11 , 12 , 24 ]. Moreover, IVUS plays a crucial role in optimizing the diagnostic process and averting unnecessary stenting particularly in cases of refractory coronary artery spasm resistant to nitroglycerin [ 12 , 24 , 42 ]. Therefore, when feasible, it is advisable to utilize IVUS prior to PCI when the cause of coronary stenoses remains unclear [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

A Rare Encounter: Unstable Vasospastic Angina Induced by Thyrotoxicosis

Širvys,

Baranauskas,

Budrys

2024

JCM

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Coronary artery vasospasm plays a crucial role in the prevalence of unstable angina. Despite common misdiagnosis, there is limited evidence on this topic. Here, we present a rare case of unstable vasospastic angina in a female with severe thyrotoxicosis. Case Report: A 62-year-old female patient was admitted to the cardiac intensive care unit due to crushing chest pain at rest. The patient exhibited ischemic changes on the ECG with a normal troponin I level. Recurrent chest pain prompted urgent coronary angiography, revealing generalized vasospasm of all coronary artery branches including the left main coronary artery. Intracoronary nitroglycerin injection partially alleviated the vasospasm; however, there was a persistent stenosis in the left main artery. Subsequent intravascular ultrasound demonstrated an anatomically normal left main artery. Post-procedure, laboratory tests revealed undetectable levels of thyroid-stimulating hormone and thyroid hormones above the detectable level. The patient was initiated on methimazole and discharged symptom-free, expecting a good prognosis under conservative management. Conclusions: Clinically significant coronary vasospasm triggered by thyrotoxicosis remains a rarity in clinical practice, often posing diagnostic challenges. This case emphasizes the significance of intracoronary nitroglycerin and intravascular ultrasound in discerning the etiology of coronary lesions seen on angiography. We advocate for these techniques to optimize invasive coronary artery diagnostics, enabling the selection of the appropriate treatment strategies and improving long-term prognosis.

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Section: Discussionmentioning

confidence: 99%

A Rare Encounter: Unstable Vasospastic Angina Induced by Thyrotoxicosis

Širvys,

Baranauskas,

Budrys

2024

JCM

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“…Supply/demand mismatch, the pathophysiological ground of the so-called type II myocardial infarction, is most commonly due to arrhythmias, hypotension, and hypoxia. As approximately half of patients experiencing such a mismatch are not shown to have a significant CAD, they may be classified as MINOCA [31].…”

Section: Minoca and Pathophysiological Mechanismsmentioning

confidence: 99%

Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA): Focus on Coronary Microvascular Dysfunction and Genetic Susceptibility

Severino,

D’Amato,

Prosperi

et al. 2023

JCM

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Among the most common causes of death worldwide, ischemic heart disease (IHD) is recognized to rank first. Even if atherosclerotic disease of the epicardial arteries is known as the leading cause of IHD, the presence of myocardial infarction with non-obstructive coronary artery disease (MINOCA) is increasingly recognized. Notwithstanding the increasing interest, MINOCA remains a puzzling clinical entity that can be classified by distinguishing different underlying mechanisms, which can be divided into atherosclerotic and non-atherosclerotic. In particular, coronary microvascular dysfunction (CMD), classifiable in non-atherosclerotic mechanisms, is a leading factor for the pathophysiology and prognosis of patients with MINOCA. Genetic susceptibility may have a role in primum movens in CMD. However, few results have been obtained for understanding the genetic mechanisms underlying CMD. Future studies are essential in order to find a deeper understanding of the role of multiple genetic variants in the genesis of microcirculation dysfunction. Progress in research would allow early identification of high-risk patients and the development of pharmacological, patient-tailored strategies. The aim of this review is to revise the pathophysiology and underlying mechanisms of MINOCA, focusing on CMD and actual knowledge about genetic predisposition to it.

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“…Gdchelated contrast agents have been employed in MRI scans of MI to provide higher contrast enhancements at the infarcted sites approximately 10 to 15 minutes after administration since they clear more slowly from the infarcted area than from the normal myocardium. 152,153 Nevertheless, Gd-chelated contrast agents cannot distinguish between MI sites and edema areas, 154 and require high dose injections, increasing the risk of nephrogenic fibrosis. 155,156 Thus, new contrast agents for the diagnosis of AMI are called for.…”

Section: The Applications Of Mno 2 Nanomaterials In Disease Diagnosismentioning

confidence: 99%

Advances in the application of manganese dioxide and its composites for theranostics

Hao

Zhao

et al. 2023

Inorg. Chem. Front.

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Myocardial Infarction With Non-obstructive Coronary Arteries: An Updated Overview of Pathophysiology, Diagnosis, and Management

Cited by 6 publications

References 42 publications

A Rare Encounter: Unstable Vasospastic Angina Induced by Thyrotoxicosis

A Rare Encounter: Unstable Vasospastic Angina Induced by Thyrotoxicosis

Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA): Focus on Coronary Microvascular Dysfunction and Genetic Susceptibility

Advances in the application of manganese dioxide and its composites for theranostics

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