Clinical Overview of Myocardial Infarction WithoutObstructive Coronary Artey Disease (MINOCA)

Shamsi, Fahad; Hasan, Khwaja Yousuf; Hashmani, Shahrukh; Jamal, Syed Farrukh; Ellaham, Samer

doi:10.37616/2212-5043.1232

Cited by 4 publications

(3 citation statements)

References 36 publications

(23 reference statements)

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“…At the same time, in the context of sepsis, reflex tachycardia increases the myocardial oxygen demand. Of course, the presence of atheroma plaques is a risk factor for the unfavorable evolution in patients with sepsis, increasing the risk of acute myocardial injury [ 61 , 62 ], but COVID-19 is also highly associated with non-atherosclerotic coronary perfusion impairment, such as spasm of the coronary arteries, dissection of the coronary wall, microthrombosis in the context of the hypercoagulant state, or vasculitis-like injury of the coronary vessels [ 63 , 64 ]. Regardless of the intimate mechanism of COVID-19-related myocardial infarction with non-obstructive coronary arteries, the patients’ prognosis is poor, with high mortality rates mainly due to the increased prevalence of severe comorbidities, such as ARDS, obesity, or congenital thrombophilia [ 64 , 65 ].…”

Section: Cardiovascular Pathophysiology Related To Covid-19 and The M...mentioning

confidence: 99%

A Real Pandora’s Box in Pandemic Times: A Narrative Review on the Acute Cardiac Injury Due to COVID-19

Timpau

Miftode

Leca

et al. 2022

Life

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The intricate relationship between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the cardiovascular system is an extensively studied pandemic topic, as there is an ever-increasing amount of evidence that reports a high prevalence of acute cardiac injury in the context of viral infection. In patients with Coronavirus disease 2019, COVID-19, a significant increase in serum levels of cardiac troponin or other various biomarkers was observed, suggesting acute cardiac injury, thus predicting both a severe course of the disease and a poor outcome. Pathogenesis of acute cardiac injury is not yet completely elucidated, though several mechanisms are allegedly involved, such as a direct cardiomyocyte injury, oxygen supply-demand inequity caused by hypoxia, several active myocardial depressant factors during sepsis, and endothelial dysfunction due to the hyperinflammatory status. Moreover, the increased levels of plasma cytokines and catecholamines and a significantly enhanced prothrombotic environment may lead to the destabilization and rupture of atheroma plaques, subsequently triggering an acute coronary syndrome. In the present review, we focus on describing the epidemiology, pathogenesis, and role of biomarkers in the diagnosis and prognosis of patients with acute cardiac injury in the setting of the COVID-19 pandemic. We also explore some novel therapeutic strategies involving immunomodulatory therapy, as well as their role in preventing a severe form of the disease, with both the short-term outcome and the long-term cardiovascular sequelae being equally important in patients with SARS-CoV-2 induced acute cardiac injury.

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Section: Cardiovascular Pathophysiology Related To Covid-19 and The M...mentioning

confidence: 99%

A Real Pandora’s Box in Pandemic Times: A Narrative Review on the Acute Cardiac Injury Due to COVID-19

Timpau

Miftode

Leca

et al. 2022

Life

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“…Although ACS may be attributed to the presence of acute thrombosis or severe obstructive, atherosclerotic disease, which are evident in coronary angiography (CAG) in most cases, this criterion may not be met in a large minority of cases [2]. Similar observations have been made in patients with myocardial infarction (MI) with nonobstructive coronary arteries, who exhibit clinical evidence of MI, but CAG does not reveal any obstructions [3]. Further, disorders such as small vessel disease, coronary embolism, hematologic disease leading to in situ thrombosis, and congenital anomalies can also cause acute MI in the presence of healthy coronary arteries or without significant stenosis [2].…”

mentioning

confidence: 92%

Viral myopericarditis masquerading as acute coronary syndrome: Diagnostic role of cardiac MRI

Kapardhi

2022

Indian J Case Reports

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Myopericarditis is commonly misdiagnosed as an acute coronary syndrome (ACS) due to the similarities in clinical presentation. Hence, accurate diagnosis is important to ensure appropriate care and improve outcomes. Here, we present the case of a 58-year-old male initially diagnosed with ACS, which was eventually identified to be a case of myopericarditis and managed accordingly. The patient presented with fever for 1 week during the coronavirus disease pandemic and developed signs of ACS subsequently. Clinical history, biomarker profile, and echocardiogram suggested ACS. However, cardiac magnetic resonance imaging and coronary angiography findings revealed myopericarditis and it was managed accordingly. Clinicians should be aware of myopericarditis masquerading as ACS in the post-viral period.

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“…Acute myocardial infarction (AMI) is associated with a high mortality ratio of up to 42% [1][2][3]. In most cases of acute myocardial ischemia cases, the reason is defined as coronary heart disease with significant stenosis or occlusion of one or more main coronary arteries.…”

Section: Introductionmentioning

confidence: 99%

Ejection Fraction-Related Differences of Baseline Characteristics and Outcomes in Troponin-Positive Patients without Obstructive Coronary Artery Disease

Kacmaz,

Schlettert,

Kreimer

et al. 2024

JCM

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Background: The development and course of myocardial infarction with non-obstructive coronary artery (MINOCA) disease is still not fully understood. In this study, we aimed to examine the baseline characteristics of in-hospital outcomes and long-term outcomes of a cohort of troponin-positive patients without obstructive coronary artery disease based on different left ventricular ejection fractions (LVEFs). Methods and results: We included a cohort of 254 patients (mean age: 64 (50.8–75.3) years, 120 females) with suspected myocardial infarction and no obstructive coronary artery disease (MINOCA) in our institutional database between 2010 and 2021. Among these patients, 170 had LVEF ≥ 50% (84 females, 49.4%), 31 patients had LVEF 40–49% (15 females, 48.4%), and 53 patients had LVEF < 40% (20 females, 37.7%). The mean age in the LVEF ≥ 50% group was 61.5 (48–73) years, in the LVEF 40–49% group was 67 (57–78) years, and in the LVEF < 40% group was 68 (56–75.5) years (p = 0.05). The mean troponin value was highest in the LVEF < 40% group, at 3.8 (1.7–4.6) µg/L, and lowest in the LVEF ≥ 50% group, at 1.1 (0.5–2.1) µg/L (p = 0.05). Creatine Phosphokinase (CK) levels were highest in the LVEF ≥ 50% group (156 (89.5–256)) and lowest in the LVEF 40–49% group (127 (73–256)) (p < 0.05), while the mean BNP value was lowest in the LVEF ≥ 50% group (98 (48–278) pg/mL) and highest in the <40% group (793 (238.3–2247.5) pg/mL) (p = 0.001). Adverse in-hospital cardiovascular events were highest in the LVEF < 40% group compared to the LVEF 40–49% group and the LVEF ≥ 50% group (56% vs. 55% vs. 27%; p < 0.001). Over a follow-up period of 6.2 ± 3.1 years, the all-cause mortality was higher in the LVEF < 40% group compared to the LVEF 40–49% group and the LVEF ≥ 50% group. Among the different factors, LVEF < 40% and LVEF 40–49% were associated with an increased risk of in-hospital cardiovascular events in the multivariable Cox regression analysis. Conclusions: LVEF has different impacts on in-hospital cardiovascular events in this cohort. Furthermore, LVEF influences long-term all-cause mortality.

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Clinical Overview of Myocardial Infarction WithoutObstructive Coronary Artey Disease (MINOCA)

Cited by 4 publications

References 36 publications

A Real Pandora’s Box in Pandemic Times: A Narrative Review on the Acute Cardiac Injury Due to COVID-19

A Real Pandora’s Box in Pandemic Times: A Narrative Review on the Acute Cardiac Injury Due to COVID-19

Viral myopericarditis masquerading as acute coronary syndrome: Diagnostic role of cardiac MRI

Ejection Fraction-Related Differences of Baseline Characteristics and Outcomes in Troponin-Positive Patients without Obstructive Coronary Artery Disease

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