Coeliac Disease: A Rare Cause of Myocardial Infarction With Non-Obstructive Coronary Arteries

Abstract

Myocardial infarction with non-obstructive coronary arteries (MINOCA) poses a diagnostic dilemma. Identifying the underlying etiology is essential to ensuring appropriate management. Cardiac magnetic resonance (CMR) is a valuable tool that can aid clinicians for that purpose. Coeliac disease (CD) is characterized by hypercoagulability and a thrombotic state and represents an exceptional cause of MINOCA. We report the case of a 28-year-old woman who presented with chest pain. The diagnosis of non-ST-elevation MI was obtained based on ECG abnormalities and elevated troponin levels. Coronary angiography was normal. CMR showed late gadolinium enhancement in the lateral left ventricular wall, confirming the diagnosis of MINOCA. A duodenal biopsy allowed the diagnosis of CD. Anticoagulation and a gluten-free diet proved beneficial, with a good outcome after a five-year follow-up. This case highlights the essential role of CMR in MINOCA investigations and the importance of thorough etiological assessment in young patients with no cardiovascular risk factors.

Keywords: anticoagulation; cardiac magnetic resonance; coeliac disease; myocardial infarction; thrombosis.

Figure 1. A coronary angiogram of our patient shows normal coronary arteries. A: left anterior oblique view of the right coronary artery and its branches; B: right anterior oblique view of the left coronary artery and its branches

Figure 2. CMR of our patient, late gadolinium enhancement sequence, long axis (A), median short axis (B), and apical short axis (C) views showing near transmural LGE at the medial and apical segments of the left ventricle’s inferolateral wall (orange arrows).

LV: left ventricle; RV: right ventricle.