Atherothrombosis is not the sole cause of myocardial infarction (MI). The clinical picture of MI of different origin is similar to the classical one. At the same time, coronaroangiography reveals changes in coronary arteries of patients with MI without atherosclerotic obstruction varying from totally intact vessels to atherosclerosis responsible for their 50% narrowing. MI without atherosclerotic obstruction is rarely encountered in clinical practice but regularly occurs in patients with acute coronary syndrome. Atherosclerotic obstruction was absent in 9-10% of the women and 7-8% of men with IM and ST segment elevation. Coronaroangiography demonstrated similar changes in women having MI without ST segment elevation. Men with the same condition exhibited atherosclerotic obstruction only in 4-7% of the cases. Unstable angina was associated with an enhanced frequency of unaffected coronary arteries which increased the difference between the two sexes. MI without atherosclerotic obstruction may be caused by a spasm of coronary arteries, eccentrically located plaques, Takotsubo syndrome, microvascular spasm, myocarditis caused by PVB19 virus, coronary embolism, thrombophilia, spontaneous dissection of coronary arteries, and their abnormalities. Patients having MI without atherosclerotic obstruction require evaluation of the risk of therapy on an individual basis.
Recurrent spontaneous dissection affecting different coronary arteries of a young female
