CAD
Myocardial Infarction with Nonobstructive Coronary Arteries
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Myocardial Infarction with Nonobstructive Coronary Arteries
, MINOCA
See Also
Heart Disease in Women
Myocardial Infarction
Takotsubo Cardiomyopathy
Spontaneous Coronary Artery Dissection
Coronary Artery Vasospasm
Definitions
Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA)
Term first assigned in 2013 to describe a common
Coronary Angiography
finding
Positive biomarkers and MI findings with <50% coronary stenosis on angiography, and no alternative diagnosis
Epidemiology
MINOCA accounts for 15% of
Myocardial Infarction
s
Female predominance (RR 5)
Younger patients (mean age 61 years old)
Ethnicity: More common in black and hispanic patients
Findings
NSTEMI
in 70-80% of cases
Often lack typical CAD risk factors (e.g.
Hypertension
,
Hyperlipidemia
)
However, many MINOCA patients do have
Diabetes Mellitus
or
Obesity
Diagnosis
Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA)
Positive cardiac biomarkers (e.g.
Troponin
) AND
Clinical evidence of
Myocardial Infarction
AND
No significant epicardial
Coronary Artery
stenosis on coronary angiogram (<50%) AND
No alternative diagnosis for the MI presentation
Causes
Coronary Artery
Plaque
Disruption
Coronary Artery
embolism or thrombosis
Coronary Artery Vasospasm
Coronary Microvascular Dysfunction
Spontaneous Coronary Artery Dissection
(
SCAD
)
Differential Diagnosis
Takotsubo Cardiomyopathy
Myocarditis
Nonischemic
Cardiomyopathy
Management
See
Takotsubo Cardiomyopathy
See
Spontaneous Coronary Artery Dissection
See
Myocarditis
See
Coronary Artery Vasospasm
Gene
ral Measures
Treat based on underlying cause
Tobacco Cessation
Cardiac Rehabilitation
Avoid stimulants (e.g.
Cocaine
,
Methamphetamine
s, pseudophedrine)
Avoid other triggering medications (e.g.
Triptan
s)
Coronary Artery
Plaque
Disruption is treated in similar way to obstructive coronary disease (but without stenting)
Aspirin
(or
Dual Antiplatelet Therapy
)
High Intensity
Statin
Left Ventricular Dysfunction
See
Heart Failure
Beta Blocker
s
ACE Inhibitor
s or
Angiotensin Receptor Blocker
s
Coronary embolism or thrombosis
Antithrombotic agents (
Anticoagulation
)
Address underlying mechanisms for
Thrombophilia
Coronary Microvascular Dysfunction
Beta Blocker
s or
Calcium Channel Blocker
s
Long Acting Nitrates
Consider Ranolazine as second-line agent
References
Yildiz (2022) Front Cardiovasc Med 9:1032436 +PMID: 36457805 [PubMed]
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