MINOCA 2024

Question 1

Diagnosis of MINOCA

Answer 1

1. AMI per 4th universal definition
   a) Increase troponin level > 99th percentile PLUS
   b)
   - Chest pain
   - ECG changes
   - New Q waves
   - ARC imagerie
   - Thrombus using angiography or autopsy
2. No > 50% stenosis of epicardial artery
3. No clinically overt specific cause for the acute presentation (r/o myocarditis, takutsubo)

Question 2

Diagnostic pathway for minoca

Answer 2

Minoca (working diagnosis)

1. Perform diagnostic invasive coronary angiogram + LV angiogram to evaluate for SCAD and if available at time of angiogram, perform OCT
2. R/o alternative explanation for clinical presentation – Takutsubo, cardiac contusion, tachyarrhythmias, pulmonary embolism, cardiotoxins, severe sepsis
3. Do TEE and review angiogram to look for missed SCAD, side branch occlusion or obstructive CAD. Consider second opinion
4. MRI and/or return to Cath lab for OCT during hospitalisation

Question 3

OCT in MINOCA

Answer 3

1. Negative – consider Ach or ergonovine provocation for coronary microvascular dysfunction
2. Intimal bumping – epicardial spasm
3. Rupture, erosion, calcified nodule – plaque disruption
4. Intimal tear, intramural hematoma – SCAD
5. Coronary embolus – thrombophilia screen, tee, hematology consult

Question 4

Traitement selon inoca

Answer 4

Question 5

Vasospastic angina diagnosis

Answer 5

Question 6

Microvascular dysfonction diagnosis

Answer 6