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Cardiac
Diagnosis
Coronary Artery Disease
Nonatherosclerosis Myocardial Infarction
Nonatherosclerosis Myocardial Infarction
Darragh Brady, MD; John Duignan, MB BCh, BAO, MRCPI; Jonathan D. Dodd, MD, MSc, MRCPI, FFR(RCSI)
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Definitions

            • Myocardial infarction (MI) unrelated to coronary atherosclerosis
              • Typically (though not always), there are no obstructed epicardial coronary arteries, so-called "MINOCA"

          IMAGING

          • General Features

            • Radiographic Findings

              • CT Findings

                • MR Findings

                  • Echocardiographic Findings

                    • Angiographic Findings

                      • Nuclear Medicine Findings

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Natural History & Prognosis

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Consider

                                      Selected References

                                      1. Ibanez B et al: 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 39(2):119-77, 2018
                                      2. Manolis AS et al: Acute coronary syndromes in patients with angiographically normal or near normal (non-obstructive) coronary arteries. Trends Cardiovasc Med. ePub, 2018
                                      3. Joseph L et al: Non-atherosclerotic vascular disease in women. Curr Treat Options Cardiovasc Med. 19(10):78, 2017
                                      4. Mihatov N et al: Type 2 myocardial infarction due to supply-demand mismatch. Trends Cardiovasc Med. 27(6):408-417, 2017
                                      5. Pathik B et al: Troponin-positive chest pain with unobstructed coronary arteries: incremental diagnostic value of cardiovascular magnetic resonance imaging. Eur Heart J Cardiovasc Imaging. 17(10):1146-52, 2016
                                      6. Pasupathy S et al: Myocardial infarction with non-obstructive coronary arteries - diagnosis and management. Eur Cardiol. 10(2):79-82, 2015
                                      7. Silvanto A et al: Myocardial infarction with normal coronaries: an autopsy perspective. J Clin Pathol. 65(6):512-6, 2012
                                      8. Yurtdaş M et al: A case of coronary spasm with resultant acute myocardial infarction: likely the result of an allergic reaction. Intern Med. 51(16):2161-4, 2012
                                      9. Kim JA et al: Less common causes of disease involving the coronary arteries: MDCT findings. AJR Am J Roentgenol. 197(1):125-30, 2011
                                      10. Leurent G et al: Diagnostic contributions of cardiac magnetic resonance imaging in patients presenting with elevated troponin, acute chest pain syndrome and unobstructed coronary arteries. Arch Cardiovasc Dis. 104(3):161-70, 2011
                                      11. Budoff MJ et al: Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY trial. J Am Coll Cardiol. 52(21):1724-32, 2008
                                      12. Kardasz I et al: Myocardial infarction with normal coronary arteries: a conundrum with multiple aetiologies and variable prognosis: an update. J Intern Med. 261(4):330-48, 2007
                                      13. Larsen AI et al: Characteristics and outcomes of patients with acute myocardial infarction and angiographically normal coronary arteries. Am J Cardiol. 95(2):261-3, 2005
                                      14. Villines TC et al: Diffuse nonatherosclerotic coronary aneurysms: an unusual cause of sudden death in a young male and a literature review. Cardiol Rev. 13(6):309-11, 2005
                                      15. Caussin C et al: Coronary plaque burden detected by multislice computed tomography after acute myocardial infarction with near-normal coronary arteries by angiography. Am J Cardiol. 92(7):849-52, 2003
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Imaging

                                          • Top Differential Diagnoses

                                            • Clinical Issues

                                              TERMINOLOGY

                                              • Definitions

                                                • Myocardial infarction (MI) unrelated to coronary atherosclerosis
                                                  • Typically (though not always), there are no obstructed epicardial coronary arteries, so-called "MINOCA"

                                              IMAGING

                                              • General Features

                                                • Radiographic Findings

                                                  • CT Findings

                                                    • MR Findings

                                                      • Echocardiographic Findings

                                                        • Angiographic Findings

                                                          • Nuclear Medicine Findings

                                                            DIFFERENTIAL DIAGNOSIS

                                                              PATHOLOGY

                                                              • General Features

                                                                CLINICAL ISSUES

                                                                • Presentation

                                                                  • Demographics

                                                                    • Natural History & Prognosis

                                                                      • Treatment

                                                                        DIAGNOSTIC CHECKLIST

                                                                        • Consider

                                                                          Selected References

                                                                          1. Ibanez B et al: 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 39(2):119-77, 2018
                                                                          2. Manolis AS et al: Acute coronary syndromes in patients with angiographically normal or near normal (non-obstructive) coronary arteries. Trends Cardiovasc Med. ePub, 2018
                                                                          3. Joseph L et al: Non-atherosclerotic vascular disease in women. Curr Treat Options Cardiovasc Med. 19(10):78, 2017
                                                                          4. Mihatov N et al: Type 2 myocardial infarction due to supply-demand mismatch. Trends Cardiovasc Med. 27(6):408-417, 2017
                                                                          5. Pathik B et al: Troponin-positive chest pain with unobstructed coronary arteries: incremental diagnostic value of cardiovascular magnetic resonance imaging. Eur Heart J Cardiovasc Imaging. 17(10):1146-52, 2016
                                                                          6. Pasupathy S et al: Myocardial infarction with non-obstructive coronary arteries - diagnosis and management. Eur Cardiol. 10(2):79-82, 2015
                                                                          7. Silvanto A et al: Myocardial infarction with normal coronaries: an autopsy perspective. J Clin Pathol. 65(6):512-6, 2012
                                                                          8. Yurtdaş M et al: A case of coronary spasm with resultant acute myocardial infarction: likely the result of an allergic reaction. Intern Med. 51(16):2161-4, 2012
                                                                          9. Kim JA et al: Less common causes of disease involving the coronary arteries: MDCT findings. AJR Am J Roentgenol. 197(1):125-30, 2011
                                                                          10. Leurent G et al: Diagnostic contributions of cardiac magnetic resonance imaging in patients presenting with elevated troponin, acute chest pain syndrome and unobstructed coronary arteries. Arch Cardiovasc Dis. 104(3):161-70, 2011
                                                                          11. Budoff MJ et al: Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY trial. J Am Coll Cardiol. 52(21):1724-32, 2008
                                                                          12. Kardasz I et al: Myocardial infarction with normal coronary arteries: a conundrum with multiple aetiologies and variable prognosis: an update. J Intern Med. 261(4):330-48, 2007
                                                                          13. Larsen AI et al: Characteristics and outcomes of patients with acute myocardial infarction and angiographically normal coronary arteries. Am J Cardiol. 95(2):261-3, 2005
                                                                          14. Villines TC et al: Diffuse nonatherosclerotic coronary aneurysms: an unusual cause of sudden death in a young male and a literature review. Cardiol Rev. 13(6):309-11, 2005
                                                                          15. Caussin C et al: Coronary plaque burden detected by multislice computed tomography after acute myocardial infarction with near-normal coronary arteries by angiography. Am J Cardiol. 92(7):849-52, 2003