Intracoronary Full Physiology and Imaging Unveiling a Rare Cause of MINOCA Presenting as Ventricular Fibrillation.

Q4 Medicine

JACC. Case reports Pub Date : 2025-09-25 DOI:10.1016/j.jaccas.2025.105481

Maria Federica Crociani, Carlo Di Mario, Niccolò Ciardetti, Giulia Nardi, Silvia Maiani, Francesca Di Muro, Matteo Orlandi, Lucrezia Biagiotti, Francesco Meucci, Alessio Mattesini

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引用次数: 0

Abstract

Background: Nonobstructive coronary artery disease is diagnostically challenging, especially in patients with recurrent chest pain and inconclusive imaging. Coronary functional abnormalities, such as vasospasm, microvascular dysfunction, and myocardial bridging, are key contributors to ischemia.

Case summary: A 57-year-old man with cardiovascular risk factors and a 10-year history of chest pain, empirically treated with vasodilators, presented with ST-segment elevation and ventricular fibrillation. Coronary angiography showed normal arteries. Invasive assessment with optical coherence tomography and coronary physiology revealed diffuse, nonobstructive lipid-rich atherosclerosis and a myocardial bridge in the mid left anterior descending artery. Ischemia was confirmed by resting full-cycle ratio. Coronary function testing showed microvascular dysfunction. Beta-blockers normalized indices, with symptom resolution at 6 months.

Discussion: This case illustrates the diagnostic value of invasive imaging and physiology in patients with myocardial infarction/myocardial ischemia with no obstructive coronary artery disease (INOCA/MINOCA).

Take-home messages: Invasive physiology and imaging are crucial for diagnosing ischemia mechanisms in nonobstructive coronary artery disease. Empirical therapy without functional assessment may delay effective, personalized treatment.

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冠状动脉内全生理和成像揭示了一种罕见的以心室颤动为表现的MINOCA病因。

背景：非阻塞性冠状动脉疾病的诊断具有挑战性，特别是在反复胸痛和影像学不确定的患者中。冠状动脉功能异常，如血管痉挛、微血管功能障碍和心肌桥接，是导致缺血的关键因素。病例总结：一名57岁男性，有心血管危险因素，胸痛病史10年，经验性使用血管扩张剂治疗，表现为st段抬高和心室颤动。冠状动脉造影显示动脉正常。有创性光学相干断层扫描和冠状动脉生理检查显示弥漫性、非阻塞性富含脂质动脉粥样硬化和左前降支中部心肌桥。静息全周期比证实缺血。冠状动脉功能检查显示微血管功能障碍。-受体阻滞剂使指数正常化，6个月时症状消退。讨论：本病例说明有创影像及生理检查在无阻塞性冠状动脉疾病（INOCA/MINOCA）的心肌梗死/心肌缺血患者中的诊断价值。结论：有创生理学和影像学对诊断非阻塞性冠状动脉疾病的缺血机制至关重要。没有功能评估的经验性治疗可能会延迟有效的个性化治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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