Pustjens Tobias, van 't Hof Arnoud W J, Lenderink Timo, Rasoul Saman
Zuyderland Medisch Centrum, afd. Cardiologie, Heerlen.
Contact: T. Pustjens (
Ned Tijdschr Geneeskd. 2019 Nov 25;163:D4046.
Myocardial infarction with nonobstructive coronary arteries (MINOCA) has multiple potential underlying causes which can be subdivided into coronary, myocardial and non-cardiac disorders. On the basis of three case descriptions, we show that additional investigations are crucial in determining the underlying mechanism and starting suitable treatment. Depending on clinical presentation, risk factors and medical history, an LV angiogram, a provocation test with intracoronary acetylcholine and a cardiac MRI can contribute to finding the correct diagnosis. We further present a diagnostic algorithm to guide the clinician in the management of patients presenting with MINOCA.
非阻塞性冠状动脉心肌梗死(MINOCA)有多种潜在的根本原因,可细分为冠状动脉、心肌和非心脏疾病。基于三个病例描述,我们表明,进一步的检查对于确定潜在机制和开始适当治疗至关重要。根据临床表现、危险因素和病史,左心室血管造影、冠状动脉内乙酰胆碱激发试验和心脏磁共振成像有助于做出正确诊断。我们还提出了一种诊断算法,以指导临床医生对MINOCA患者进行管理。