Byline: Shafeajafar. Zoofaghari, Fariborz. Nikaen, Shahrzad. Bahramsari, Mozhdeh. Hashemzadeh, Gholamali. Dorooshi
Myocardial infarction (MI) with nonobstructive coronary arteries (MINOCA) is syndrome with clinical evidence of acute MI (AMI) with normal coronary arteries. This study reports the case of a 23-year-old single woman referring to the hospital with clinical manifestations of MI, with electrocardiography findings of slow ventricular tachycardia or accelerated idioventricular rhythm and atrioventricular dissociation, and high troponin levels, which was admitted with the diagnosis of MINOCA due to mental stress (grief) and was discharged after 4 days of monitoring and following stabilization of conditions and absence of symptoms. Other causes of MINOCA ruled out through imaging studies. Mental stress can lead to MINOCA.
Myocardial infarction (MI) with no obstructive coronary atherosclerosis (MINOCA) is a distinct clinical syndrome characterized by evidence of MI with normal or near normal coronary arteries on angiography. MINOCA is a syndrome with multiple potential causes. They may involve the epicardial vessels and/or the coronary microcirculation. Coronary artery spasm, acute thrombosis at the site of nonobstructive eccentric plaque thrombosis, Takotsubo cardiomyopathy, coronary microvascular dysfunction, viral myocarditis, and coronary artery embolism can be considered as the causes of MINOCA. The clinical presentation of MINOCA patients is similar to that of acute coronary syndrome (ACS) patients with obstructive coronary artery disease (CAD). However, MINOCA patients are younger and more often women. The prevalence of MINOCA among all cases of MI is about 6% and ranges between 1% and 14%, and its mortality is lower than MI and CAD (2%-3.3% in year).
The management of MINOCA is due to the underlying cause. In the current clinical practice, the treatment for MINOCA patients is highly variable. Secondary prophylactic drugs are less frequently used in these patients than in patients with CAD and in women less than men. This is likely to indicate a lack of transparency regarding the mechanisms involved in individuals and groups of patients. Some physicians may not be confident about the diagnosis of these patients compared to patients with severe CAD with MI. Since the rising of troponin that can happen due to tension and neurologic stress, or due to pathological mechanisms underlying infarction in absence of coronary artery obstruction (CAO), the importance of systematic research to reach a definitive diagnosis and proper treatment is highlighted. In this study, we report a MINOCA case of a 23-year-old woman which complained of retrosternal chest pain that extended to the left arm, nausea, vomiting, and dyspnea with no history of cardiovascular diseases.
A 23-year-old 60 kg-weighted single woman referred to Shariati Hospital, Isfahan, Iran, with history of depression and acute mental stress following an episode of grief with no drug abuse and coronary risk factors (she did not present any information about her substance abuse) and no recent respiratory infections except recently use of sertraline 50 mg and trifluoperazine 1 mg daily orally for reducing stress. She complained of retrosternal chest pain that extended to the left arm, nausea, vomiting, and dyspnea. On the electrocardiography (ECG),...