Background : The prevalence of MINOCA in patients with antiphospholipid syndrome (APLS) is estimated to be 20%. Frequent causes in this population include coronary vasospasm, microcirculatory dysfunction and takotsubo cardiomyopathy. Objective : This case reveals myocarditis and coronary vasospasm as newly described complications of APLS associated MINOCA and illustrates the use of CMR to differentiate ischemic injury from myocarditis in this population. Case : A 40-year-old female presented with two-days of left-sided, substernal, pleuritic, and radiating chest pain associated with dyspnea. Admission ECG showed 0.5mm ST elevations in the inferior leads with ST depression in aVL. She had an initial high sensitivity troponin of 1531 ng/L, NT-proBNP of 18,357 pg/mL, baseline creatinine of 1.53 mg/dL, platelets of 95,000/μL, hemoglobin of 8.4 g/dL, and a subtherapeutic INR of 1.1 on warfarin. An emergent catheterization showed no coronary artery disease or evidence of SCAD. TTE showed hypokinesis of inferior and lateral walls with an LVEF of 45% and CTA chest ruled out pulmonary embolism. The patient’s admission was complicated by rising troponins to a peak of 9790 ng/L, oliguric renal failure requiring continuous renal replacement therapy, and fever. Patient was medically managed for presumed myocardial infarction and repeat TTE two days after catheterization showed a recovered LVEF of 59%. CMR showed a transmural infarct of the basal and inferior walls with signs of microvascular obstruction and diffuse patchy late gadolinium enhancement of the LV midwall, consistent with myocarditis. An infectious workup for myocarditis was negative. Patient was discharged home on warfarin, aspirin, and amlodipine. Conclusion : MINOCA is more common in patients with APLS, although coronary vasospasm and myocarditis have not been described in the same patient. CMR is useful to differentiate the etiology of ischemic injury following successful diagnosis of MINOCA.