Table 2.
Underlying mechanisms and selective diagnostic investigations of myocardial infarction with no obstructive coronary artery disease (MINOCA)
| Underlying mechanism | Selective diagnostic investigations |
|---|---|
| Ischemic presentation (MINOCA) | |
| Atherosclerosis | |
| Plaque rupture | Angiographic review |
| Plaque erosion | Functional assessment |
| Calcified nodule | Intracoronary imaging |
| Epicardial coronary vasospasm | Angiographic review |
| Resolution with intracoronary | |
| vasodilators such as intracoronary | |
| nitroglycerin | |
| Spasm provocation testing | |
| Coronary microvascular dysfunction testing | Angiographic review |
| Coronary microvascular function | |
| testing | |
| Stress PET or CMRI with MBFR | |
| Coronary thrombosis or embolism | Angiographic review |
| Intracoronary imaging | |
| Blood tests and genetic studies | |
| Spontaneous coronary artery dissection | Angiographic review |
| Intracoronary imaging | |
| Fixed atherosclerosis + supply–demand mismatch OR Supply–demand mismatch alone | Review of potential stressors |
| Clinically overlooked nonischemic presentation (MINOCA mimickers) | |
| Cardiac causes | |
| Takotsubo | Left ventricular angiogram |
| Contrast CMRI | |
| Myocarditis | Contrast CMRI |
| Cardiomyopathy | Contrast CMRI |
| Extracardiac causes | |
| Pulmonary embolism | Review of clinical context |
| Sepsis | |
| Cardiac contusion | |
| Other noncardiac causes of elevation of CTn levels | |
CMRI, cardiac magnetic resonance imaging; CTn, cardiac troponins; MBFR; myocardial blood flow reserve: PET, positron emission tomography.