Myocardial Infarction with Nonobstructive Coronary Arteries: A Diagnostic Challenge

Abstract

Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a significant cause of cardiovascular morbidity, especially among non-white women younger than 55 years. It is a working diagnosis that warrants further investigation due to its varied underlying pathophysiologic mechanisms. Investigations may be hampered by unavailability of testing modalities, cost, and the expertise to carry out the tests, as they are highly specialized. Clinical history is therefore important, especially in developing countries, to predict potential causes and institute empirical treatment without the luxury of tests. Some physicians are also unaware of this phenomenon and may dismiss symptoms as functional when a coronary angiogram shows nonobstructed coronary arteries, potentially resulting in patients suffering symptoms for longer and incurring extra cost. Most importantly, it leaves them at risk of major adverse cardiovascular events. This article presents a patient with atrial fibrillation who was diagnosed with MINOCA and highlights the diagnostic challenges in evaluating MINOCA.

Práticas Clínicas Aplicadas a Pacientes Com Infarto Do Miocárdio Sem Obstrução De Artéria Coronária (Minoca)

“…Observou-se um acometimento maior em pessoas do sexo feminino, não brancas e mais jovens, com menos de 55 anos. (4) É observado que pacientes com MINO-CA representam um grande desafio terapêutico, sendo seu manejo embasado em evidências ainda limitadas. Acreditava-se que os pacientes apresentavam prognóstico benigno, porém, estudos realizados com pacientes que tinham infarto sem obstrução coronariana significativa, identificaram risco aumentado de morte e de novos eventos adversos cardiovasculares maiores (MACE).…”