Cardiac magnetic resonance (CMR) imaging with late gadolinium enhancement (LGE) is a key modality in providing localisation and characterisation of myocardial injury in patients diagnosed with myocardial infarction with non-obstructive coronary arteries (MINOCA). We present a case that demonstrates the unique ability of CMR to provide crucial information in instances of uncertainty. A 71-year-old patient with dilated cardiomyopathy (DCM) presented with symptoms suggestive of acute myocardial infarction. The diagnosis of MINOCA was confirmed following coronary angiography. CMR imaging with LGE confirmed presence of apical infarction. Quantitative myocardial perfusion mapping demonstrated severely reduced blood flow in the non-infarcted septal segments proximal to the distal infarcted territory. The precise aetiology of apical infarction remains uncertain and is likely attributed to coronary plaque rupture. However, concomitant severe regional microvascular dysfunction is also appreciated. This is a recognised, but not well described, phenomenon in DCM and may contribute to repetitive ischaemic injury and disease progression.
- heart failure
- radiology (diagnostics)
- ischaemic heart disease
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Contributors TAK contributed to the collection of the history and data for this case report, consent of the patient, writing up the case report and literature review. BAM and SN contributed to revision of the manuscript and literature review. GPM was the treating cardiologist in our case report and contributed to revision of the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Patient consent for publication Obtained.
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