Myocardial Infarction With Non-obstructive Coronary Arteries (MINOCA) in a High-Risk Young Man: A Case Report

TL;DR

A young man with high cardiovascular risk had a heart attack despite non-obstructive coronary arteries, highlighting the challenges in diagnosing and treating MINOCA.

Contribution

This case report adds to the understanding of MINOCA in young adults and emphasizes the need for advanced imaging and further research on optimal management strategies.

Findings

A 27-year-old man with type 2 diabetes and obesity presented with chest pain and ST-segment elevation, but no obstructive coronary lesions were found.

Cardiac MRI confirmed an apical transmural myocardial infarction, supporting a diagnosis of MINOCA.

The case underscores the importance of advanced imaging and highlights diagnostic and therapeutic challenges in young adults with MINOCA.

Abstract

Acute coronary syndrome (ACS) in young adults with non-obstructive coronary arteries presents diagnostic and therapeutic challenges. Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a relatively uncommon but clinically significant entity, often caused by coronary vasospasm, microvascular dysfunction, or plaque erosion, requiring careful differentiation from other ischemic and non-ischemic causes.

We report the case of a 27-year-old Moroccan man with a high cardiovascular risk profile, including newly diagnosed type 2 diabetes, obesity, active smoking, and a family history of coronary artery disease, who presented to the emergency department with severe, persistent chest pain and ST-segment elevation on electrocardiography (ECG). Given the ST-segment elevation MI (STEMI)-mimicking presentation and lack of immediate angiography access, fibrinolysis was administered, though symptom persistence later suggested MINOCA. An angiography was conducted, revealing no obstructive coronary lesions. Further investigation with cardiac magnetic resonance imaging (MRI) confirmed an apical transmural MI. The patient's course was managed with dual antiplatelet therapy, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, and statins, with anti-anginal agents added upon the recurrence of angina.

This case illustrates the diagnostic complexities of MINOCA in young adults with ACS presentations and highlights the importance of advanced imaging to confirm MI and guide treatment. Future research should address optimal acute management (e.g., fibrinolysis vs. conservative strategies) and the role of intracoronary imaging (intravascular ultrasound (IVUS)/optical coherence tomography (OCT)) in MINOCA.

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