![]() ![]() Overall, CMR shows myocarditis in approximately 30%, MI in 25%, Takotsubo in 20% and normal myocardium in 25% of MINOCA patients. Cardiac magnetic resonance (CMR) imaging has developed into an important tool for further investigation of MINOCA, due to its ability to distinguish normal myocardium from Takotsubo syndrome, cardiomyopathies, and tissue scarring due to MI or myocarditis. The prognosis of MINOCA was previously perceived as excellent but has later been shown to be serious, with a 1-year all-cause mortality rate of 3.5%. In comparison with patients with MI-CAD, MINOCA patients are more likely to be younger and female and less likely to have treated hyperlipidemia, although other cardiovascular risk factors are similar. The prevalence of MINOCA is around 5-10% of all MIs, and approximately one third of patients present with ST-segment elevation on the electrocardiogram (ECG). Therefore, MINOCA should be considered a working diagnosis, warranting further investigation of the underlying cause. Myocarditis, Takotsubo syndrome, cardiomyopathies, cardiac trauma, and tachyarrhythmias are accounted for as cardiac causes, and stroke, pulmonary embolism, sepsis, renal failure, and hypoxemia are examples of extra-cardiac causes. Coronary causes are occult plaque rupture or erosion, coronary spasm, spontaneous coronary artery dissection, coronary embolization, and coronary microvascular disorders. The etiology of MINOCA is heterogeneous and can be divided into coronary, cardiac and extra-cardiac causes. The diagnostic criteria for MINOCA have been proposed as 1) fulfilling the universal definition for MI, 3 2) having non-obstructive coronary arteries on angiography (<50% stenosis) and 3) no clinically overt specific cause for the acute presentation. This group is referred to as myocardial infarction with non-obstructive coronary arteries (MINOCA). 1,2 However, the widespread use of highly sensitive troponin assays and coronary angiography have revealed that a substantial group of MI patients lack significant (≥50%) coronary stenoses. The prognosis for myocardial infarction (MI) due to coronary artery disease (CAD) has improved over the last decades due to the development of coronary care units and early revascularization strategies. CMR (cardiovascular magnetic resonance) imaging might be considered a standard examination when the underlying cause is not identified.The etiology of MINOCA is heterogenous thus, MINOCA should be considered a working diagnosis warranting further investigation to identify the underlying mechanism.MINOCA (myocardial infarction with non-obstructive coronary arteries) is common (5-10% of all myocardial infarctions). ![]()
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