MINOCA Resulting from Coronary Spasm Confirmed Angiographically without Ergonovine Stimulation: A Case Report

Abstract

Introduction: Myocardial infarction with nonobstructive coronary arteries disease (MINOCA) encompasses a heterogeneous group of disorders. Multimodality imaging is crucial to figure out the underlying mechanism. Coronary artery spasm is a common cause of MINOCA and might be difficult to identify. Case Presentation: A 43-year-old male with no cardiovascular risk factor presented with prolonged acute chest pain at 5 am that resolved spontaneously. On admission, he was asymptomatic and clinical findings were unremarkable. The electrocardiogram showed an anterolateral negative T wave. The troponin was positive. Coronary angiography (CA) revealed a moderate lesion of the proximal left anterior descending (LAD) coronary artery. He was treated with dual antiplatelet therapy, statin, and beta-blocker with a favourable hospital course. One week later, he presented chest pain recurrences with anterior ST-segment elevation. CA, without intra-radial nitrate, owing to a vasospasm suspicion, showed a sub-occlusion of the proximal LAD which resolved after intracoronary nitrates. Chest pain and ST-segment elevation then disappeared. He remained asymptomatic and was discharged on CCB (calcium channel blocker), long-acting nitrates dual antiplatelet and statin. Cardiac magnetic resonance (CMR) demonstrated an ejection fraction (EF) of 45% with anterior ischemia. Conclusion: Our case is about a common cause of MINOCA, namely coronary spasm, diagnosed by coronary angiogram without provocative test.