Abstract
The diagnosis and management of myocardial infarction with non-obstructive coronary arteries (MINOCA) presents a formidable challenge to clinicians due to its multifaceted etiologies and underlying pathophysiological mechanisms. Etiologies encompass a spectrum including myopericarditis, coronary vasospasm, microvascular diseases, coronary artery embolism, and takotsubo syndrome, among others. Despite its clinical significance, leading medical organizations need more consensus guidelines delineating the optimal approach to MINOCA diagnosis, treatment, and follow-up. In this case report, we elucidate a complex case of a 65-year-old male devoid of significant cardiovascular history who presented with characteristic chest pain, ST-segment elevation on electrocardiography, and markedly elevated troponin levels. Coronary angiography revealed non-obstructive coronary vessels, posing a diagnostic conundrum. Subsequent literature reviews of advanced imaging modalities such as cardiac magnetic resonance imaging (MRI) and coronary angiography with cardiac biopsy were noted to be pivotal in elucidating the specific etiology of MINOCA, which otherwise posed a diagnostic challenge. Ultimately, the patient was diagnosed with MINOCA secondary to myopericarditis, underscoring the importance of a comprehensive diagnostic approach in such cases. This case underscores the critical role of advanced imaging techniques in delineating the underlying pathology of MINOCA and emphasizes the necessity for individualized management strategies tailored to the specific etiology. Furthermore, we discuss potential strategies for optimizing the diagnostic workup and discharge planning following coronary angiography in patients with MINOCA.