Badero Olurotimi J, Osibowale Bamikole, Asogwa Francis C, Dosumu Adebomi, Omokore Olutomiwa
Department of Interventional Cardiology, Iwosan Lagoon Hospitals, Lagos, NGA.
Department of Interventional Cardiology, Division of Cardio-Nephrology, Cardiac Renal & Vascular Associates, Jackson, USA.
Cureus. 2025 Aug 6;17(8):e89511. doi: 10.7759/cureus.89511. eCollection 2025 Aug.
Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a group of heterogeneous diseases with different pathological mechanisms. It is often under-recognized because of its diverse differential diagnoses like myocarditis, takotsubo cardiomyopathy, spontaneous coronary artery dissection (SCAD), coronary microvascular dysfunction, vasospasm, coronary erosion, and embolism. Evaluation with multimodality imaging including intravascular coronary imaging and cardiac magnetic resonance is often necessary to determine the underlying etiology and management. We report a case of MINOCA in Nigeria involving a 55-year-old woman with metabolic syndrome who experienced cardiac arrest following an intra-abdominal procedure with an electrocardiogram (ECG) and biomarkers consistent with myocardial injury but had non-obstructive coronary artery disease (CAD) on angiography. This case underscores the need to consider MINOCA in patients presenting with myocardial infarction and non-obstructive coronary angiogram, particularly those with multiple comorbidities, and the need for a comprehensive diagnostic approach to uncover the underlying mechanism. Our report encourages increased clinical index of suspicion of this condition while contributing to the growing body of knowledge of this underdiagnosed clinical entity.
非阻塞性冠状动脉心肌梗死（MINOCA）是一组具有不同病理机制的异质性疾病。由于其鉴别诊断多样，如心肌炎、应激性心肌病、自发性冠状动脉夹层（SCAD）、冠状动脉微血管功能障碍、血管痉挛、冠状动脉糜烂和栓塞等，它常常未得到充分认识。通常需要采用包括血管内冠状动脉成像和心脏磁共振在内的多模态成像进行评估，以确定潜在病因并制定治疗方案。我们报告一例尼日利亚的MINOCA病例，患者为一名55岁患有代谢综合征的女性，在腹部手术过程中发生心脏骤停，心电图（ECG）和生物标志物显示与心肌损伤相符，但血管造影显示冠状动脉疾病（CAD）无阻塞。该病例强调，对于出现心肌梗死且冠状动脉造影无阻塞的患者，尤其是那些患有多种合并症的患者，需要考虑MINOCA，并且需要采用全面的诊断方法来揭示潜在机制。我们的报告鼓励提高对这种疾病的临床怀疑指数，同时为这一诊断不足的临床实体的知识积累做出贡献。
