Allison Elizabeth L, Palmer Wayne-Andrew, Rattan Keston, Seenarine Nitish, Schrem Ezra, Mills Robert, Mitre Cristina A
Department of Internal Medicine, State University of New York Downstate Medical Center, Brooklyn, USA.
Department of Cardiology, State University of New York Downstate Medical Center, Brooklyn, USA.
Cureus. 2024 Jul 9;16(7):e64135. doi: 10.7759/cureus.64135. eCollection 2024 Jul.
Myocardial infarction with non-obstructive coronary arteries (MINOCA) is defined by the presence of positive cardiac biomarkers with clinical evidence of infarction, the absence of significant coronary stenosis (≥50%) on angiography, and the lack of alternative diagnosis for the index presentation. MINOCA poses a diagnostic and therapeutic challenge due to the various pathophysiologic mechanisms underlying its presentation. Coronary artery plaque disruption is recognized as a crucial mechanism contributing to MINOCA. Plaque rupture and thrombus formation with subsequent myocardial ischemia may occur without significant luminal narrowing. A high index of suspicion is needed to make an early diagnosis. Here, a 68-year-old African American male patient presented with substernal chest pain, nonspecific ST segment changes on electrocardiogram, and elevation in cardiac biomarkers only one day after undergoing diagnostic cardiac catheterization that revealed non-obstructed coronary arteries. This case provides an example of MINOCA occurring secondary to suspected coronary artery plaque disruption in the setting of recent cardiac catheterization.
非阻塞性冠状动脉心肌梗死（MINOCA）的定义为：存在心肌梗死的临床证据且心脏生物标志物呈阳性，血管造影显示无显著冠状动脉狭窄（≥50%），且该指数表现无其他替代诊断。由于MINOCA呈现的多种病理生理机制，它带来了诊断和治疗方面的挑战。冠状动脉斑块破裂被认为是导致MINOCA的关键机制。斑块破裂和血栓形成随后导致心肌缺血，可能在无明显管腔狭窄的情况下发生。需要高度怀疑指数才能做出早期诊断。在此，一名68岁的非裔美国男性患者，在接受诊断性心导管检查显示冠状动脉无阻塞仅一天后，出现胸骨后胸痛、心电图非特异性ST段改变以及心脏生物标志物升高。该病例提供了一个在近期心导管检查背景下，疑似冠状动脉斑块破裂继发MINOCA的实例。
