scholarly journals Myocardial Infarction with Nonobstructive Coronary Artery (MINOCA)

2021 ◽  
Vol 06 (02) ◽  
pp. 115-118
Author(s):  
R. Archana
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Coronary Artery ◽  
Risk Stratification ◽  
Coronary Arteries ◽  
Diagnostic Strategy ◽  
Therapeutic Challenge ◽  
Microvascular Spasm

AbstractMyocardial infarction with nonobstructive coronary arteries (MINOCA) is diagnosed in almost equal to 5 to 6% of patients who present with acute myocardial infarction (AMI). Causes of MINOCA are varied. Appropriate diagnosis and evaluation is important to uncover the correct cause and prescribe specific therapies to treat the underlying cause.Women with evidence of MINOCA are being increasingly recognized. The mechanisms underlying MINOCA, such as coronary microvascular spasm, represent a diagnostic and therapeutic challenge to medical fraternity, as there is neither a uniform nor comprehensive diagnostic strategy for accurate risk stratification, in the present scenario, for these patients.Here, we are reporting a case of MINOCA, which is rare and incompletely evaluated.

scholarly journals The Vanishing Stenosis: ST Elevation Myocardial Infarction and Rhythm Disturbance due to Coronary Artery Spasm—Case Report and Review of the Literature

2010 ◽  
Vol 2010 ◽  
pp. 1-4
Author(s):  
J. Gosai ◽  
C. J. Malkin ◽  
E. D. Grech
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Case Report ◽  
Coronary Artery ◽  
Coronary Arteries ◽  
Coronary Artery Spasm ◽  
Coronary Arteriography ◽  
Review Of The Literature ◽  
Rhythm Disturbance ◽  
St Elevation

A 62-year-old lady was admitted with clinical and electrocardiograph features of acute myocardial infarction. Urgent coronary arteriography was performed, demonstrating a single discrete stenosis of one coronary artery. Following intracoronary injection of GTN, this stenosis completely resolved, as the symptoms did. The causes of acute myocardial infarction with normal coronary arteries are reviewed.

scholarly journals P1443 Sex differences of coronary physiology can be justified by fractional myocardial mass

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
H Y Kim ◽  
K H Kim ◽  
J H Choi
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Acute Myocardial Infarction ◽  
Coronary Artery ◽  
Gender Difference ◽  
Coronary Arteries ◽  
Clinical Presentation ◽  
Lower Prevalence ◽  
Myocardial Mass ◽  
Artery Disease

Abstract Background Women has lower prevalence of coronary artery disease but has higher mortality from acute myocardial infarction. The gender difference in the anatomical-physiological relationship may elucidate the gender difference in the clinical presentation of coronary artery disease. Purpose We hypothesized that the gender difference in the anatomical-physiological relationship may elucidate the gender difference in the clinical presentation of coronary artery disease. Background Women has lower prevalence of coronary artery disease but has higher mortality from acute myocardial infarction. The gender difference in the anatomical-physiological relationship may elucidate the gender difference in the clinical presentation of coronary artery disease. Methods In this multicenter registry, 482 patients who underwent coronary CT angiography and fractional flow reserve (FFR) measurement were enrolled. Fractional myocardial mass (FMM, a vessel-specific amount of myocardium) and %FMM (fraction of FMM to whole myocardial mass) was measured in major coronary arteries and branches. FFR and quantitative coronary angiography (QCA) were interrogated in the subset of 772 vessels. The severity of physiological or anatomical stenosis was assessed by FFR and diameter stenosis (DS), respectively. Results In the analysis of all major epicardial arteries (N = 3,833), FMM was lower in women compared to men (p < 0.01, all), but %FMM was similar between women and men (p = NS, all). Among physiologically assessed 772 vessels, compared to men (N = 587), vessels of women (N = 185) showed smaller dimension (reference diameter (RD) = 2.90 ± 0.65 vs 3.14 ± 0.69 mm, minimal luminal diameter (MLD) = 1.30±.0.57 vs 1.40 ± 0.57 mm (p < 0.05, all), similar severity of stenosis (DS = 55% vs 55% p = NS), and higher FFR (0.81 ± 0.13 vs 0.78 ± 0.15, p < 0.001). In subgroup analysis according to the tertiary categories of DS, RD, and MLD, vessels of women showed higher FFR and lower FMM. Generalized estimating equations modeling demonstrated that gender, DS, RD, MLD, and location in left anterior descending artery were not (p = NS, all) but FMM/MLD were significant predictors for FFR ≤ 0.80 (p = 0.021). Conclusions Compared to men, coronary arteries of women are smaller and supply smaller amount of myocardium even after adjusting for vessel size, which may explain overall higher FFR value of women. This gender difference in anatomical-physiological relationship may explain the gender difference in the clinical coronary artery disease. Abstract P1443 Figure.

Nonocclusive Coronary Thrombosis In Acute Myocardial Infarction

1981 ◽  
Author(s):  
R J Frink
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Coronary Artery ◽  
Acute Phase ◽  
Coronary Arteries ◽  
Coronary Thrombosis ◽  
Histologic Study ◽  
Artery Thrombosis ◽  
Coronary Artery Thrombosis ◽  
Hospital Deaths

TIn depth histologic study was performed on 23 patients who died during the acute phase or within the first three months following acute myocardial infarction. Six died suddenly and unexpectedly out of the hospital, five of these with the acute myocardial infarction unrecognized.The remainder were hospital deaths, five within the first 48 hours, 8 between 2-14 days, and 4 between 14 and 94 days. Five cases showed subendocardial infarction (SI). Four of these occuring out of hospital. The remaining 18 cases were transmural infarctions (TI). Sixteen of 17 hospital deaths exhibited TI.Special emphasis was given to a histologic search for coronary artery thrombosis, particularly nonocclusive thrombosis (NT), and fibrin fragments in the microcirculation. An acute coronary thrombus (ACT) was found in 22 of 23 (96%) cases. The ACT was totally occlusive in 12 of 23 (52%), and NT in 17 of 23 (74%). TI was associated with an acute occlusive thrombus (OT) in 11 of 18 (61%) , and with NT in 12 (67%). All five cases with SI had a NT. Seven (30%) exhibited both an OT and NT located in different coronary arteries. Six of these had TI.Fibrin fragments were located in the microcirculation of the myocardium in 15 of 23 (65%). These were associated with the fresh OT in 8 of 15 (53%) and with a NT in 12 of 15 (80%).Conclude: 1. NT is more common than OT in deaths associated with acute myocardial ’infarction 2. Fibrin fragments are present in the majority of patients with ACT, particularly NT. 3. SI was consistently asscoiated with NT. 4. OT and NT are frequently present in different arteries in the same heart. 5. NT are common in patients with TI.

Association of short-term exposure to air pollution with myocardial infarction with and without obstructive coronary artery disease

2020 ◽  
pp. 204748732090464 ◽  
Author(s):  
Masanobu Ishii ◽  
Tomotsugu Seki ◽  
Koichi Kaikita ◽  
Kenji Sakamoto ◽  
Michikazu Nakai ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Acute Myocardial Infarction ◽  
Air Pollution ◽  
Coronary Artery ◽  
Coronary Arteries ◽  
Odds Ratio ◽  
Short Term ◽  
Short Term Exposure ◽  
Artery Disease

Background Air pollution including particulate matter with an aerodynamic diameter ≤2.5 µm (PM2.5) increases the risk of acute myocardial infarction. However, whether short-term exposure to PM2.5 triggers the onset of myocardial infarction with nonobstructive coronary arteries, compared with myocardial infarction with coronary artery disease, has not been elucidated. This study aimed to estimate the association between short-term exposure to PM2.5 and admission for acute myocardial infarction, myocardial infarction with coronary artery disease, and myocardial infarction with nonobstructive coronary arteries. Design This was a time-stratified case-crossover study and multicenter validation study. Methods This study used a nationwide administrative database in Japan between April 2012–March 2016. Of 137,678 acute myocardial infarction cases, 123,633 myocardial infarction with coronary artery disease and 14,045 myocardial infarction with nonobstructive coronary arteries were identified by a validated algorithm combined with International Classification of Disease (10th revision), diagnostic, and procedure codes. Air pollutants and meteorological data were obtained from the monitoring station nearest to the admitting hospital. Results In spring (March–May), the short-term increase of 10 µg/m3 in PM2.5 2 days before admission was significantly associated with admission for acute myocardial infarction, myocardial infarction with nonobstructive coronary arteries, and myocardial infarction with coronary artery disease after adjustment for meteorological variables (odds ratio 1.060, 95% confidence interval 1.038–1.082; odds ratio 1.151, 1.079–1.227; odds ratio 1.049, 1.026–1.073, respectively), while the association was not significant in other variables. These associations were also observed after adjustment for other co-pollutants. The risk for myocardial infarction with nonobstructive coronary arteries (vs myocardial infarction with coronary artery disease) was associated with an even lower concentration of PM2.5 under the current environmental standards. Conclusions This study showed the seasonal difference of acute myocardial infarction risk attributable to PM2.5 and the difference in the threshold of triggering the onset of acute myocardial infarction subtype.

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