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Case Reports
. 2019 Oct 23;12(10):e231731.
doi: 10.1136/bcr-2019-231731.

Non-ST elevation myocardial infarction, non-obstructive coronary arteries and severe regional microvascular dysfunction in a patient with dilated cardiomyopathy

Thomas A Kite  1 , Benjamin A Marrow  1 , Sarah Nduwayo  1 , Gerry P McCann  1
Affiliations
Case Reports

Non-ST elevation myocardial infarction, non-obstructive coronary arteries and severe regional microvascular dysfunction in a patient with dilated cardiomyopathy

Thomas A Kite et al. BMJ Case Rep. .

Abstract

Cardiac magnetic resonance (CMR) imaging with late gadolinium enhancement (LGE) is a key modality in providing localisation and characterisation of myocardial injury in patients diagnosed with myocardial infarction with non-obstructive coronary arteries (MINOCA). We present a case that demonstrates the unique ability of CMR to provide crucial information in instances of uncertainty. A 71-year-old patient with dilated cardiomyopathy (DCM) presented with symptoms suggestive of acute myocardial infarction. The diagnosis of MINOCA was confirmed following coronary angiography. CMR imaging with LGE confirmed presence of apical infarction. Quantitative myocardial perfusion mapping demonstrated severely reduced blood flow in the non-infarcted septal segments proximal to the distal infarcted territory. The precise aetiology of apical infarction remains uncertain and is likely attributed to coronary plaque rupture. However, concomitant severe regional microvascular dysfunction is also appreciated. This is a recognised, but not well described, phenomenon in DCM and may contribute to repetitive ischaemic injury and disease progression.

Keywords: heart failure; ischaemic heart disease; radiology; radiology (diagnostics).

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Admission ECG.
Figure 2
Figure 2
Cardiac magnetic resonance late gadolinium enhancement imaging.
Figure 3
Figure 3
Cardiac magnetic resonance quantitative myocardial perfusion imaging.
See this image and copyright information in PMC

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