Abstract
RATIONALE: Myocardial infarction with nonobstructive coronary arteries (MINOCA) has diverse ischemic etiologies and has been defined by the absence of angiographically significant obstructive coronary artery disease. Blood transfusion has seldom been reported as a precipitating factor for MINOCA. Here, we present a rare case of transfusion-associated MINOCA in a young woman without underlying chronic conditions, aiming to raise clinical awareness of this uncommon yet important phenomenon and to explore its potential pathophysiological mechanisms. PATIENT CONCERNS: A 30-year-old woman with acute anemia secondary to abnormal uterine hemorrhage developed MINOCA and cardiogenic shock following blood transfusion. DIAGNOSES: Abnormal uterine hemorrhage, anemia, MINOCA, cardiogenic shock. INTERVENTIONS: The patient received hemocoagulase and oxytocin to control vaginal bleeding. Anemia was managed with a total transfusion of 6 units of erythrocytes. Coronary angiography was performed promptly after the diagnosis of acute coronary syndrome. Vasopressin was administered to manage cardiogenic shock. Clopidogrel, ticagrelor, nicorandil, and rosuvastatin were prescribed to promote the recovery of coronary microvascular function. OUTCOMES: Electrocardiographic changes resolved within hours, and left ventricular ejection fraction improved from 44% to 66% by 1 month. The patient completed a 6-minute walk test without symptoms and remained stable, with resolution of anemia and full cardiac recovery. LESSONS: The delicate balance between hemorrhage and hemostasis was emphasized. Treatment strategies for blood transfusion-induced MINOCA remain limited, and our therapeutic approach may provide an effective option for clinical practice.