The Imaging Toolbox to Assess Patients with Suspected Myocardial Infarction in the Absence of Obstructive Coronary Arter
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MANAGEMENT OF ACUTE CORONARY SYNDROMES (H JNEID, SECTION EDITOR)
The Imaging Toolbox to Assess Patients with Suspected Myocardial Infarction in the Absence of Obstructive Coronary Artery Disease (MINOCA) Soheila Talebi 1 & Pedro Moreno 1 & Abel Casso Dominguez 2 & Jacqueline E. Tamis-Holland 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review This paper will review myocardial infarction with non-obstructive coronary arteries (MINOCAs) briefly, and then focus on the imaging tools that should be employed when caring for patients with suspected MINOCA. Recent Findings Diagnostic imaging has a critical role in assessing patients with suspected or confirmed MINOCA. The extent at which these diagnostic tests are used in any given patient will depend on the clinical acumen for the underlying condition, as well as the available resources. Summary There are myriad conditions that can lead to MINOCA; further testing to exclude other underlying causes of myocardial injury is crucial. Cardiovascular imaging may assist in identifying the etiological cause in cases where MINOCA remains the most likely diagnosis. A systematic approach to the diagnostic assessment will help to uncover the underlying diagnosis, guide therapy, and provide the patient and their families with appropriate feedback. Keywords MINOCA . Cardiac diagnostic imaging
Background and Introduction Coronary angiography in the clinical context of acute myocardial infarction (AMI) identifies obstructive coronary artery
This article is part of the Topical Collection on Management of Acute Coronary Syndromes Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11886-020-01379-x) contains supplementary material, which is available to authorized users. * Jacqueline E. Tamis-Holland [email protected] Soheila Talebi [email protected] Pedro Moreno [email protected] Abel Casso Dominguez [email protected] 1
Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY, USA
2
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
disease (CAD) in approximately 85–95% of patients. For these patients with significant CAD, the benefits of revascularization and cardioprotective therapies are well established and supported in clinical practice guidelines [1, 2]. However, in up to 15% of patients with clinical diagnostic features of AMI, early angiography does not reveal obstructive CAD [3–6]. A diagnosis of myocardial injury with non-obstructive CAD should prompt further investigation to determine whether there is indeed an ischemic mechanism of myocardial injury, (and therefore an AMI with no obstructive CAD (MINOCA) or whether a non-ischemic mechanism of myocardial injury is responsible for the clinical presentation (Table 1). The American Heart Association [7••] and European Society of Cardiology [8] have published consensus documents defining MINOCA and outlining the various etiologies responsible for t
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