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CASE20191028_017
| CORONARY - Acute Coronary Syndromes (STEMI, NSTE-ACS) | |
| Myocardial Infarction with Non-Obstructive Coronary Artery (MINOCA): How We Deal with It | |
| Miftahurrahmah Galuh Mayang Sari1, Yahya Berkahanto Juwana2, Herawati Isnanijah1, Rido Sukaton3 | |
| Pasar Rebo General Hospital Jakarta, Indonesia1, Rs Pondok Indah, Indonesia2, RSUD Pasar Rebo, Indonesia3, | |
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[Clinical Information]
- Patient initials or identifier number:
ESS
-Relevant clinical history and physical exam:
A 29 years old male was admitted with typical chest pain of infarction with the onset of five hours. His coronary risk factor was cigarette smoker and lately he was in a heavy stress at work.
-Relevant test results prior to catheterization:
His electrocardiography on admission showed ST elevation at inferolateral wall (II, III, aVf, V5, V6). His laboratory test showed significant high level of CKMB and Troponin T.
  - Relevant catheterization findings:
His Coronary angiography result revealed no significant stenosis in RCA, LM, LAD, and LCx. However, in the mid distal of LAD showed a muscular bridging.
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[Interventional Management]
- Procedural step:
Right radial artery was punctured after 2 % lidocain, introducer sheath size 6 F. The angiography of RCA was large caliber vessel without significant stenosis, TIMI 3 flow with blush grade 1-2. The angiography of LAD was average caliber vessel withmuscular bridging causing 75 % stenosis in mid part when systole. The angiography of LM and LCx were average caliber vessel without any stenosis. As we see the angiography, we perfomed RCA and LCA with intracoronary heparin 2500 IUeach and Nitroglyserin 100 micro each. The patient relieved after the procedure and better blush grade (3).
 3 RCA.mov- Case Summary:
MINOCA was identified as an increasing of biomarkers and electrocardiogram changes without obstructive coronary artery disease. The management of MINOCA at this moment is still based on limited evidence.
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