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BUT — Cardiac catheterization done a little later did not reveal any significant stenosis. Despite the absence of significant coronary stenosis on her post-arrest cath — the ECG in Figure-1 is clearly diagnostic of an extensive anterolateral STEMI ( presumably from acute LAD [ L eft A nterior D escending ] coronary artery occlusion).
MINOCA may be due to: coronary spasm, coronary microvascular dysfunction, plaque disruption, spontaneous coronary thrombosis/emboli , and coronary dissection; myocardial disorders, including myocarditis, takotsubo cardiomyopathy, and other cardiomyopathies. There may be a chronic tight stenosis and a non-obstructed lesion that thrombosed.
link] A 62 year old man with a history of hypertension, type 2 diabetes mellitus, and carotid artery stenosis called 911 at 9:30 in the morning with complaint of chest pain. Smith's comments in the May 19, 2020 post : — Non-obstructive coronary disease does not ne cessarily imply no plaque rupture with thrombus. It is not rare.
History sounds concerning for ACS (could be critical stenosis, triple vessel), but differential also includes dissection, GI bleed, etc. 2 cases of Aortic Stenosis: Diffuse Subendocardial Ischemia on the ECG. His response: “subendocardial ischemia. Anything more on history? POCUS will be helpful.” Left main? 3-vessel disease?
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