MINOCA , Myocardial Infarction �with Non-Obstructive Coronary Arteries

Myocardial Infarction with Non-Obstructive Coronary Arteries
Mechanisms for ischemic heart disease in women.
CMR imaging in MINOCA

1. Myocardial Infarction with Non-Obstructive Coronary Arteries: A Whole New Ball Game. Magdy El- Masry Prof. of Cardiology Tanta University MINOCA

2. A Changing Philosophy Nonobstructive disease is not a false positive. It's not benign. Non-obstructive Coronary Arteries Myocardial Infarction Ischemia

3. Normal coronary angiogram. A smooth patent covetable left main, LAD, and circumflex projected from the screen. Next to these innocent-appearing vessels was a distinctly sinister IVUS study from the same angiogram demonstrating plaque rupture and ulceration.

4. What we can see is only 5% of the total coronary tree . ? Coronary Microvascular Dysfunction Non-obstructive Coronary Arteries

5. Mechanisms for ischemic heart disease in women . *Plaque disruption denotes plaque rupture or plaque erosion

6. Diagnostic Criteria For Myocardial Infarction With Non-obstructive Coronary Arteries “MINOCA”

7. A potential problem with current AMI criteria is their central focus upon troponins, since clinicians encounter elevated troponins in clinical scenarios other than AMI.

8. Circulation. 2017;135:1490–1493.

9. MINOCA: A case study of a 55-year-old woman with an anterior STEMI presentation.

10. MINOCA should be considered as a ‘working diagnosis’, analogous to heart failure, and thus prompts further evaluation regarding its underlying mechanism(s).

11. MINOCA: A case study of a 55-year-old woman with an anterior STEMI presentation.

12. MINOCA Etiology

13. Etiology of MINOCA : Differential diagnosis work up

14. Recommended diagnostic and therapeutic algorithm for myocardial infarction with non-obstructive coronary arteries.

15. Diagnostic test flow chart in MINOCA.

16. Diagnostic test flow chart in MINOCA , Cont.

17. CMR imaging is a key investigation in identifying the underlying cause

18. Coronary angiography portraying subtle lesion ( arrow) involving the mid LAD Cardiac MRI revealing LGE of the mid to distal anteroseptal wall ( arrows). Still frames from horizontal long axis (top row) and short axis (bottom row) are consistent with mid to distal LAD infarction Ann Clin Lab Res . 2016, 4: 3.

19. Bar graph of published studies showing the diagnostic significance of CMR imaging in MINOCA patients . Data presented as percentage (%). Cardiac magnetic resonance (CMR) imaging findings in patients with MINOCA.

20. Management A fundamental consideration is identifying the underlying cause of this heterogeneous syndrome because that will determine appropriate therapy. 

21. All-Cause Mortality in Patients With MINOCA or MI-CAD Data presented as percentage (%) and 95% confidence intervals (%) with odds ratio (OR) and P values. MI-CAD indicates myocardial infarction with coronary artery disease; and MINOCA , myocardial infarction with nonobstructive coronary arteries Circulation 2015;131(10):861–870 MINOCA : is not a benign condition?

22. Guarded Prognosis Hence patients with MINOCA should receive the same clinical attention as AMI patients who have single- or double-vessel disease and not merely dismissed as having an insignificant clinical condition. Although the outcome of MINOCA strongly depends on the underlying cause, its overall prognosis is serious, with a 1 year mortality of about 3.5%.

23. Circulation. 2017;135:1481–1489

24. Dr. Noel Bairey Merz is the director of the Barbra Streisand Women's Heart Center at Cedars Sinai and is a leader in female cardiovascular treatment.  "In a session on New Practice Patterns in Clinical Cardiology at the  European Society of Cardiology 2017 Congress , she gave a presentation titled "A Women's Clinic for Heart Disease." Her talk outlined three distinct sub clinic options where women with heart disease can seek help: The MINOCA (myocardial infarction without obstructive coronary artery disease) clinic, the HFpEF (heart failure with preserved ejection fraction) clinic, and the APO (adverse pregnancy outcomes) clinic." “ The MINOCA Clinic ”