ECG Guru - Instructor Resources - MINOCA https://www.ecgguru.com/ecg/minoca en Myocardial Infarction With Non-obstructive Coronary Arteries https://www.ecgguru.com/ecg/myocardial-infarction-non-obstructive-coronary-arteries <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/myocardial-infarction-non-obstructive-coronary-arteries"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/AW125%20MINOCA.jpg" width="1800" height="715" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p class="MsoNormal"><span style="font-size: 12.0pt; line-height: 107%;">This ECG was obtained from a 37-year-old male who was complaining of non-radiating substernal chest pain.<span style="mso-spacerun: yes;">&nbsp; </span>He offered no significant medical history.<span style="mso-spacerun: yes;">&nbsp; </span>He denied taking any medications.<span style="mso-spacerun: yes;">&nbsp; </span>He was hypertensive and bradycardic on arrival in the Emergency Dept. He was alert and ambulatory.<span style="mso-spacerun: yes;">&nbsp; </span>Approximately 20 minutes after first being seen by paramedics, he suffered an episode of ventricular fibrillation in the E.D.<span style="mso-spacerun: yes;">&nbsp; </span>He was resuscitated and sent to the cath lab.<span style="mso-spacerun: yes;">&nbsp; </span>His coronary arteries were without lesions.<span style="mso-spacerun: yes;">&nbsp; </span>We do not know the results of any lab tests, including troponins.</span></p><p class="MsoNormal"><strong style="mso-bidi-font-weight: normal;"><span style="font-size: 12.0pt; line-height: 107%; color: #00b050;">What does the ECG show?<span style="mso-spacerun: yes;">&nbsp; </span></span></strong><strong style="mso-bidi-font-weight: normal;"><span style="font-size: 12.0pt; line-height: 107%;">The rhythm </span></strong><span style="font-size: 12.0pt; line-height: 107%;">is sinus bradycardia at a rate of 48 bpm. <strong style="mso-bidi-font-weight: normal;">The PR, QTc, intervals and QRS duration </strong>are normal. <span style="mso-spacerun: yes;">&nbsp;</span><strong style="mso-bidi-font-weight: normal;">The QRS frontal plane axis</strong> is normal and there is good R wave progression in the precordial leads.<span style="mso-spacerun: yes;">&nbsp; </span>There is <strong style="mso-bidi-font-weight: normal;">ST segment elevation</strong> in Leads I, aVL, V2, and V3, with reciprocal ST depression in Leads III and aVF.<span style="mso-spacerun: yes;">&nbsp; </span>The ST segments that are elevated retain a relatively “normal” shape, being concave upward. There are no abnormal T wave inversions or pathological Q waves.</span></p><p class="MsoNormal"><strong style="mso-bidi-font-weight: normal;"><span style="font-size: 12.0pt; line-height: 107%; color: #00b050;">Discussion<span style="mso-spacerun: yes;">&nbsp; </span></span></strong><span style="font-size: 12.0pt; line-height: 107%;">While this ECG is certainly consistent with the diagnosis of<strong style="mso-bidi-font-weight: normal;"> anterior-lateral M.I. </strong>(STEMI), the patient was found to have “clean” coronary arteries.<span style="mso-spacerun: yes;">&nbsp; </span>Any adult presenting with chest pain and ECG abnormalities should be assessed for acute M.I., of course, and that often involves a trip to the cath lab.<span style="mso-spacerun: yes;">&nbsp; </span>Most acute M.I.s are caused by a ruptured plaque in a coronary artery that has formed a blood clot and obstructed blood flow through that artery.<span style="mso-spacerun: yes;">&nbsp; </span>Other conditions can cause blood flow obstruction, such as coronary artery spasm.<span style="mso-spacerun: yes;">&nbsp; </span>An imbalance in supply and demand can also damage the heart muscle, even if not caused by thrombus. A general term for an M.I. (confirmed by troponins, echocardiography, or catheterization) is <span style="mso-spacerun: yes;">&nbsp;</span><a title="MINOCA" href="https://www.ecrjournal.com/articles/myocardial-infarction-non-obstructive-coronary-arteries-diagnosis-and-management">“MINOCA”</a>, “myocardial infarction with non-obstructive coronary arteries”.<span style="mso-spacerun: yes;">&nbsp; </span>It can occur in up to 10% of patients presenting with clinical features that are diagnostic of STEMI. There are many examples of MINOCA, including, but not limited to, <span style="mso-spacerun: yes;">&nbsp;</span>spasm, cardiomyopathies, or thrombotic disorders. Because of this patient’s presenting symptoms and subsequent episode of V Fib, we are confident that he received a thorough investigation of possible etiologies, but unfortunately, we have no results.</span></p><p class="MsoNormal"><span style="font-size: 12.0pt; line-height: 107%;">Please comment below to add to this discussion.&nbsp; We are very interested in your experiences with MINOCA.</span></p><p class="MsoNormal"><span style="font-size: 12.0pt; line-height: 107%;">Many thanks to Lew Steinberg and the Palm Beach Gardens, FL Fire Rescue Department for donating this ECG.</span></p><p class="MsoNormal"><strong style="mso-bidi-font-weight: normal;"><span style="font-size: 12.0pt; line-height: 107%;">&nbsp;</span></strong></p><p class="MsoNormal"><strong style="mso-bidi-font-weight: normal;"><span style="font-size: 12.0pt; line-height: 107%; color: #00b050;">&nbsp;</span></strong></p><p class="MsoNormal"><span style="font-size: 12.0pt; line-height: 107%;">&nbsp;</span></p></div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/735/feed" method="post" id="fivestar-custom-widget" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--2" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Myocardial Infarction With Non-obstructive Coronary Arteries 1/5</option><option value="40">Give Myocardial Infarction With Non-obstructive Coronary Arteries 2/5</option><option value="60">Give Myocardial Infarction With Non-obstructive Coronary Arteries 3/5</option><option value="80">Give Myocardial Infarction With Non-obstructive Coronary Arteries 4/5</option><option value="100" selected="selected">Give Myocardial Infarction With Non-obstructive Coronary Arteries 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >5</span></span> <span class="total-votes">(<span >1</span> vote)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-lHiiQgKVSsyKcbBLVEKuonZOqQ8yH0kPYGKzNUGzxfw" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/mi-non-obstructive-coronary-arteries" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">M.I. with non-obstructive coronary arteries</a></div><div class="field-item odd"><a href="/ecg/minoca" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">MINOCA</a></div><div class="field-item even"><a href="/ecg/stemi" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">STEMI</a></div><div class="field-item odd"><a href="/ecg/st-elevation" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">ST elevation</a></div><div class="field-item even"><a href="/ecg/acute-mi" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Acute M.I.</a></div><div class="field-item odd"><a href="/ecg/anterior-lateral-mi-0" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Anterior-lateral M.I.</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_1"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fmyocardial-infarction-non-obstructive-coronary-arteries&amp;title=Myocardial%20Infarction%20With%20Non-obstructive%20Coronary%20Arteries"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> <script type="text/javascript"> <!--//--><![CDATA[//><!-- if(window.da2a)da2a.script_load(); //--><!]]> </script></span></li> </ul> Wed, 14 Mar 2018 20:36:04 +0000 Dawn 754 at https://www.ecgguru.com https://www.ecgguru.com/ecg/myocardial-infarction-non-obstructive-coronary-arteries#comments