Case report of acute pericarditis-associated Atrial Fibrillation and thromboembolism MI with Non-Obstructive Coronary Arteries (MINOCA)

Abstract

Myocardial Infarction (MI) with non-obstructive coronary artery disease (MINOCA), defined as MI without coronary artery stenosis ≥50% on invasive angiography, makes up around 6-14% of all MI presentations with one-year all-cause mortality of 4.7%. MINOCA encompasses a heterogeneous group of conditions. Although patients with MINOCA are more likely to have associated hypercoagulable states, they have a better prognosis than patients with obstructive coronary artery disease (CAD) MI. However, 1 in 4 patients with MINOCA may experience another cardiac event in subsequent years, with women having a worse outcome than men. Treatment for MINOCA should therefore be tailored towards the precipitating aetiology as well as secondary prevention of MI for longer-term benefits. We present a case of first episode of acute pericarditis associated with new persistent atrial fibrillation (AF) leading to thromboembolic MINOCA, and highlight the management decisions to individualise treatments for the various issues specific to this case.