MI with non-obstructive coronary arteries (MINOCA) is precipitated secondary to a group of vascular or myocardial disorders. MINOCA occurs in 5–15% of patients presenting with acute ST-segment elevation MI or non-ST segment elevation MI and prognosis is impaired. Following coronary angiography after an acute MI, if there is no evidence of stenosis ≥50% in an infarct-related epicardial artery, positive cardiac biomarkers and no presence of any overt systemic aetiology for the presentation; a diagnosis of MINOCA is made. Hereby, we wish to present rare presentations of MINOCA :
1: A case of 56y/M hypertensive who presented with angina features and positive biomarkers but coronary angiogram was normal. upon taking a detailed history, we discovered a triad of symptoms suggestive of something quite surprising.
2: A case of 50y/F patient who came with chronic complaints of exertional chest pain with characteristic angina and positive biomarkers; angiogram showed anomalous origin of right coronary artery.
3: A case of 38 Y /M known case of diabetes well controlled, on regular treatment came to OPD with chief complaints of sub sternal chest pain episodic, aggravated on carrying out heavy work, relieving on rest for the last 6-7 months with angiography showing myocardial bridging.
Audience Take Away
The gloal burden of cardiovascular disorders on the overall mortality and morbidity is well known. MINOCA represents a group of disorders which manifest a significant diagnostic and therapeutic challenge to physicians. Unfortunately , physicians fail to realize that the absence of obstructive coronary arteries does not exclude the possibility of an AMI.As such, patients with MINOCA are usually misinformed about their diagnosis and inaccurately “reassured” about a favourable prognosis.With this presentation, we wish to highlight some unusual presentations of MINOCA and increase awareness about the condition as well.