Role of cardiac magnetic resonance in MINOCA of unclear etiology: a case report of a suspicious paradoxical coronary embolism.
Francesca ScabbiaMichela ZerbiniLucia PiraniRiccardo RighiMonica ViolaAda CollevecchioRoberto RizzatiBiagio SassonePublished in: BJR case reports (2023)
The acronym MINOCA (Myocardial Infarction with Non-Obstructive Coronary Arteries) refers to myocardial infarction with normal or near-normal coronary arteries on invasive angiography. The broad spectrum of pathological mechanisms responsible for myocardial injury in MINOCA makes defining the exact underlying etiology challenging. We report the uncommon case of an acute myocardial infarction with normal coronary arteries suggestive of MINOCA caused by paradoxical coronary embolism due to a wide right-to-left shunting through a patent fossa ovalis. Integrated multimodality imaging diagnostic work-up, including cardiac magnetic resonance, transesophageal contrast echocardiography, and transcranial contrast Doppler, has been crucial for identifying the most likely mechanism underlying MINOCA.
Keyphrases
- magnetic resonance
- coronary artery disease
- left ventricular
- coronary artery
- acute myocardial infarction
- aortic stenosis
- contrast enhanced
- heart failure
- computed tomography
- percutaneous coronary intervention
- high resolution
- optical coherence tomography
- magnetic resonance imaging
- mass spectrometry
- acute coronary syndrome
- ejection fraction