scholarly journals Typical ST-segment elevation myocardial infarction with normal coronary arteries: a case report

2019 ◽  
Vol 47 (11) ◽  
pp. 5903-5909
Author(s):  
Ying Rao ◽  
Yu Wang ◽  
Huang Sun ◽  
Wei Chen ◽  
Wenjuan Song ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Angiography ◽  
Coronary Arteries ◽  
Troponin I ◽  
Contrast Echocardiography ◽  
Coronary Spasm ◽  
Imaging Method ◽  
St Segment Elevation ◽  
Plaque Disruption ◽  
St Segment

Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a potentially multipathogenic syndrome that affects a subgroup of patients who present with acute myocardial infarction yet have no significant coronary artery disease on angiography. We herein describe a 71-year-old man with typical angina who showed inferior ST-segment elevation on electrocardiography and an increased troponin-I level. Emergency coronary angiography showed no angiographic stenosis. Cardiac magnetic resonance imaging (CMR) and myocardial contrast echocardiography (MCE) with two-dimensional speckle tracking imaging (2D-STI) were performed after coronary angiography. Good consistency was observed between the CMR findings and MCE with 2D-STI findings in identifying the potential causes of MINOCA. We explored an imaging method that is potentially more effective and accurate than CMR, namely MCE combined with 2D-STI, to identify myocardial abnormalities when angiography reveals no obstruction. This application of MCE with 2D-STI may optimize timely treatment. MINOCA has various causes, and the patient in this case was discharged with aspirin, verapamil, and atorvastatin on the presumption that the infarct had arisen from either plaque disruption or coronary spasm. In this study, we analyzed the etiology, clinical diagnosis, and treatment of MINOCA with reference to the relevant literature.

scholarly journals Electroangiographic Correlation of Simultaneous ST-Segment Elevations of Anterior and Inferior Segment: Who Is the Culprit?

2021 ◽  
pp. 263246362110155
Author(s):  
Pankaj Jariwala ◽  
Shanehyder Zaidi ◽  
Kartik Jadhav
Keyword(s):  
Myocardial Infarction ◽  
Coronary Angiography ◽  
Coronary Arteries ◽  
Index Case ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Inferior Segment ◽  
The Right ◽  
Proximal Occlusion

Simultaneous ST-segment elevation (SST-SE) in anterior and inferior leads in the setting of ST-segment elevation myocardial infarction is often confounding for a cardiologist and further more challenging is the angiographic localization of the culprit vessel. SST-SE can be fatal as it jeopardizes simultaneously a larger area of myocardium. This phenomenon could be due to “one lesion, one artery,” “two lesions, one artery,” “two lesions, two arteries,” or combinations in two different coronary arteries. We have discussed an index case where we encountered a phenomenon of SST-SE and coronary angiography demonstrated “two lesions, one artery” (proximal occlusion and distal critical diffuse stenoses of the wrap-around left anterior descending [LAD] artery) and “two lesions, two (different coronary) arteries” (previously mentioned stenoses of the LAD artery and critical stenosis of the posterolateral branch of the right coronary arteries). We have also described in brief the possible causes of this phenomena and their electroangiographic correlation of the culprit vessels.

scholarly journals Loeffler’s endocarditis and possible coronary spasm secondary to eosinophilic coronary periarteritis with ECG change mimicking acute non-ST-segment elevation myocardial infarction: A case report

2020 ◽  
Author(s):  
Fan-xin Kong ◽  
Meng Li ◽  
Chun-Yan Ma ◽  
Ping-ping Meng ◽  
Yong-huai Wang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Differential Diagnosis ◽  
Coronary Artery ◽  
Troponin I ◽  
Hypereosinophilic Syndrome ◽  
Coronary Spasm ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Abstract Background Loeffler’s endocarditis is an inflammatory cardiac condition of hypereosinophilic syndrome which rarely involves coronary artery. When coronary artery is involved, known as eosinophilic coronary periarteritis, the clinical presentation, electrocardiographic changes and troponin level are extremely nonspecific and may mimic acute coronary syndrome. It is very important to make differential diagnosis for ECPA in order to avoid the unnecessary further invasive coronary angiography. Case presentation We report a case with chest pain, ST-segment depression in electrocardiogram and increased troponin-I mimicking acute non-ST-segment elevation myocardial infarction. However, quick echocardiography showed endomyocardial thickening with normal regional wall motion, which corresponded to the characteristics of Loeffler’s endocarditis. Emergent blood analysis showed marked increase in eosinophils and computed tomography angiography found no significant stenosis of coronary artery. Manifestations of magnetic resonance imaging consisted with findings of echocardiography. Finally, the patient was diagnosed as Loeffler’s endocarditis and possible coronary spasm secondary to eosinophilic coronary periarteritis. Conclusion This case exhibits the crucial use of quick transthoracic echocardiography and the emergent hematological examination for differential diagnosis in such scenarios as often if electrocardiogram change mimicking myocardial infarction.

scholarly journals 588 Prognostic impact of early vs. deferred angiography in MINOCA patients

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Matteo Armillotta ◽  
Angelo Sansonetti ◽  
Sara Amicone ◽  
Francesco Angeli ◽  
Michele Fabrizio ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Angiography ◽  
Coronary Arteries ◽  
Optimal Timing ◽  
Prognostic Impact ◽  
Invasive Strategy ◽  
St Segment Elevation ◽  
St Segment ◽  
Significant Difference ◽  
All Cause Mortality

Abstract Aims Although an early invasive strategy (coronary angiography performed <24 h) is associated with a lower risk of recurrent/refractory ischaemia among patients with acute myocardial infarction (AMI) and obstructive coronary arteries, the optimal timing of invasive examination in patients with non-obstructive coronary arteries and non-ST-segment elevation presentation (NSTE-MINOCA) has not been explored. This study tested the hypothesis that, compared to early (<24 h) invasive strategy, deferred (≥24 h) coronary angiography has equivalent prognostic impact in patients with NSTE-MINOCA. Methods and results From 2016 to 2020, all consecutive MINOCA patients diagnosed according to the current ESC diagnostic criteria (angiographic conventional cut-off of < 50% coronary stenosis without a clinically apparent alternative diagnosis) and admitted to our Centre with non-ST-segment elevation myocardial infarction (NSTEMI) presentation were enrolled. Very high-risk NSTEMI patients have been excluded from the study. The prognostic value of an early (<24 h) vs. deferred (≥24 h) coronary angiography was assessed. All-cause mortality and a composite endpoint of all-cause mortality, stroke, re-hospitalization for heart failure, and myocardial re-infarction were evaluated. 198 NSTE-MINOCA patients were enrolled. MINOCA patients were more frequently females (64%) and the mean age was 68.6 ± 13.2 years. The median follow-up time was 26 (14–40) months. The total number of events was 54 (27.3%). Kaplan–Meier curves showed that there was no statistically significant difference (P = 0.88) between the two study groups depending on the time of invasive strategy adopted. Specifically, the rates of death (15% vs. 11.3%) and MACEs (28.3% vs. 25%) were similar in MINOCA patients undergoing early vs. deferred angiography. Conclusions We demonstrate for the first time that in the MINOCA population the prognosis was not influenced by an early vs. deferred coronary angiography, unlike in AMI patients with obstructive coronary arteries. These results add another piece to the puzzle and pave the way for the initial use of a non-invasive imaging strategy (e.g. Coronary-CT), mostly in patients with NSTEMI and high clinical suspicion of non-obstructive coronary arteries.

scholarly journals Acute myocardial infarction in pregnancy: spasm caused by hyperthyroidism?

2019 ◽  
Vol 47 (5) ◽  
pp. 2269-2273 ◽  
Author(s):  
LingQing Wang ◽  
JianGuang Yang ◽  
JiPing Zheng ◽  
XingJian Gu
Keyword(s):  
Myocardial Infarction ◽  
Coronary Angiography ◽  
Direct Evidence ◽  
Coronary Spasm ◽  
Coronary Risk Factors ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Early Use ◽  
History Of

We present a 26-year-old woman with ST-segment elevation myocardial infarction in the 14th week of pregnancy. Coronary angiography revealed no abnormalities in the coronary arteries. She had no history of coronary risk factors such as smoking, diabetes mellitus, hypertension, or dyslipidemia. Although we do not have direct evidence of coronary spasm in this patient, several factors suggest that coronary spasm is the most likely cause of myocardial infarction. We suspect that hyperthyroidism may have played an important role in coronary spasm in this patient. Early use of coronary angiography is helpful to identify the types of coronary artery lesions.

scholarly journals Features of the structural state of the myocardium in patients with myocardial infarction without ST segment elevation depending on the nature of the anatomical lesion of the coronary arteries

2021 ◽  
Vol 25 (4) ◽  
pp. 589-592
Author(s):  
V. Yu. Maslovsky
Keyword(s):  
Myocardial Infarction ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Coronary Angiography ◽  
Functional State ◽  
Coronary Arteries ◽  
Left Ventricular ◽  
Left Ventricular Myocardium ◽  
St Segment Elevation ◽  
St Segment

Annotation. In Ukraine, one of the most pressing medical and social problems is coronary heart disease, in particular, such a form as myocardial infarction. Also, as in most countries, coronary heart disease plays a leading role in morbidity and mortality. In Ukraine, coronary heart disease accounts for 65% of the mortality from diseases of the circulatory system of the working population and is the main cause of disability. The aim of the work is to determine the features of the structural and functional state of the myocardium in patients with myocardial infarction without ST segment elevation depending on the nature of the anatomical lesion of the coronary arteries. We conducted a comprehensive study of 200 patients with acute myocardial infarction without ST-segment elevation (NSTEMI) aged 38 to 80 years. According to coronary angiography, the degree of damage to the coronary arteries was determined, and according to echocardiography – the structural and functional state of the myocardium. Comparison of percentages between groups was performed by the criterion χ2, absolute values – by Mann-Whitney U test. The structural condition of the left ventricular myocardium in NSTEMI patients deteriorated significantly. The total severity of coronary artery disease, calculated from coronary angiography, was> 3, indicating a more severe anatomical lesion of the coronary arteries in these patients. This pathology was associated primarily with an increase in the incidence of eccentric left ventricular hypertrophy. A similar association has been established with regard to the development of left ventricular diastolic dysfunction.

scholarly journals ST-segment elevation myocardial infarction with non-obstructive coronary arteries: Score derivation for prediction based on a large national registry

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0254427
Author(s):  
Magdalena Jędrychowska ◽  
Zbigniew Siudak ◽  
Krzysztof Piotr Malinowski ◽  
Łukasz Zandecki ◽  
Michał Zabojszcz ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Angiography ◽  
Coronary Arteries ◽  
National Registry ◽  
Probability Scale ◽  
Final Model ◽  
St Segment Elevation ◽  
Non Invasive ◽  
St Segment ◽  
Percutaneous Coronary

Background Acute myocardial infarction with ST-segment elevation (STEMI) and obstructive coronary arteries (MI-CAD) are treated with primary percutaneous coronary interventions (pPCI), while patients with STEMI and non-obstructive coronary arteries (MINOCA), usually require non-invasive therapy. The aim of the study is to design a score for predicting suspected MINOCA among an overall group of STEMI patients. Materials and methods Based on the Polish national registry of PCIs, we evaluated patients between 2014 and 2019, and selected 526,490 subjects treated with PCI and 650,728 treated using only coronary angiography. These subjects were chosen out of 1,177,218 patients who underwent coronary angiography. Then, we selected 124,663 individuals treated with pPCI due to STEMI and 5,695 patients with STEMI and MINOCA. The score for suspected MINOCA was created using the regression model, while the coefficients calculated for the final model were used to construct a predictive model in the form of a nomogram. Results Patients with MINOCA differ significantly from those in the MI-CAD group; they were significantly younger, less often males and demonstrated smaller burden of concomitant diseases. The model allowed to show that patients who scored more than 600 points had a 19% probability of MINOCA, while for those scoring more than 650 points, the likelihood was 71%. The other end of the MINOCA probability scale was marginal for patients who scored less than 500 points (< .2%). Conclusions Based on the created MINOCA score presented in the current publication, we are able to distinguish MINOCA from MI-CAD patients in the STEMI group.

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