Title : Mixed connective tissue disease revealed by MINOCA syndrome
Abstract:
Introduction: Myocardial infarction with non-obstructive coronary arteries (MINOCA) is an increasingly recognized clinical entity, especially with the frequent use of angiography in acute coronary syndromes. Diagnosing MINOCA requires a thorough evaluation of multiple potential underlying mechanisms, each necessitating a distinct therapeutic approach. We present a compelling case where MINOCA was the first manifestation of mixed connective tissue disease (MCTD).
Observation
A 60-year-old female with a history of pericardial effusion presented to the emergency department with acute chest pain and shortness of breath.
• Electrocardiogram (ECG): Sinus rhythm (80 bpm) with apico-lateral repolarization abnormalities.
• Cardiac Biomarkers: Troponin levels were elevated 24× the normal range.
• Coronary Angiography: Revealed normal coronary arteries.
• Cardiac MRI: Showed systolic dysfunction of the left ventricle and an inflammatory pericardial effusion, with no signs of hypertrophic cardiomyopathy or Takotsubo cardiomyopathy.
Despite hemodynamic stability, the patient exhibited systemic symptoms including shortness of breath, puffy hands, swollen fingers, and alopecia. Autoimmune testing revealed positive antinuclear antibodies (ANA) with a high titer of U1 RNP, confirming the diagnosis of mixed connective tissue disease (MCTD). The patient was managed with corticosteroids alongside standard therapy for ischemic heart disease.
Conclusion: Diagnosing MINOCA remains a significant challenge, as its underlying etiology often remains elusive despite extensive evaluation. This case underscores the importance of considering inflammatory and autoimmune disorders, such as MCTD, in patients presenting with MINOCA, as prompt recognition and treatment can significantly alter clinical outcomes.
