University of Hertfordshire Research Archive

        JavaScript is disabled for your browser. Some features of this site may not work without it.

        Browse

        All of UHRABy Issue DateAuthorsTitlesThis CollectionBy Issue DateAuthorsTitles

        Arkivum Files

        My Downloads
        View Item 
        • UHRA Home
        • University of Hertfordshire
        • Research publications
        • View Item
        • UHRA Home
        • University of Hertfordshire
        • Research publications
        • View Item

        A rare cause of myocardial infarction with non-obstructive coronary arteries-case report of ST-segment elevation myocardial infarction caused by a mediastinal mass

        View/Open
        Final Published version (PDF, 884Kb)
        Author
        Gue, Ying X.
        Anwar, Majid
        Gorog, Diana A.
        Attention
        2299/21874
        Abstract
        Introduction ST-segment elevation myocardial infarction (STEMI) is attributable to an occluded coronary artery in almost 90% of patients. Accordingly, restoration of coronary perfusion as early as possible, preferably with primary percutaneous coronary intervention, is the recommended treatment by the European Society of Cardiology, to maximise myocardial salvage. However, not all cases of STEMI are because of coronary artery occlusion. ST-segment elevation myocardial infarction that occurs in the absence of obstructive coronary artery disease on angiography has been termed myocardial infarction with non-obstructive coronary arteries (MINOCA). Case A 44-year-old man was admitted with retrosternal chest pain radiating to the left arm and jaw, and electrocardiogpresentation raphy showed extensive anterior ST-segment elevation. Emergency coronary angiography showed all three coronary arteries were patent with Thrombolysis in Myocardial Infarction-3 flow and no evidence of dissection or thrombus. The ST-elevation and pain resolved spontaneously. Troponin-T level rose from <3 ng/L on arrival to 549 ng/L at 12 h. Subsequent cardiac magnetic resonance imaging (MRI) showed a structurally normal heart (without late gadolinium enhancement) but detected an incidental large, lobulated (90 * 31 * 71 mm) mediastinal mass containing multiple cysts in the anterior mediastinum with inflammation and oedema of the parietal pericardium. Tissue biopsy confirmed Hodgkin's lymphoma and the patient was initiated on chemotherapy. Discussion Some 3% of ST-segment myocardial infarctions occur in the absence of obstructive coronary disease (MINOCA), is more frequent in younger patients. Cardiac MRI is a useful tool to both identify some of the potential causes of MINOCA and also to confirm the diagnosis of infarction. Some 26% of MINOCA patients have significant biochemical evidence of myocardial injury but have a normal cardiac MRI. This case illustrates a very rare cause of myocardial infarction in a young patient with unobstructed coronary arteries, and highlights the need in such cases for further detailed imaging of the myocardium and thorax to establish the diagnosis and initiate appropriate treatment.
        Publication date
        2018-03-01
        Published in
        European Heart Journal - Case Reports
        Published version
        https://doi.org/10.1093/ehjcr/yty008
        License
        http://creativecommons.org/licenses/by/4.0/
        Other links
        http://hdl.handle.net/2299/21874
        Relations
        School of Life and Medical Sciences
        Metadata
        Show full item record
        Keep in touch

        © 2019 University of Hertfordshire

        I want to...

        • Apply for a course
        • Download a Prospectus
        • Find a job at the University
        • Make a complaint
        • Contact the Press Office

        Go to...

        • Accommodation booking
        • Your student record
        • Bayfordbury
        • KASPAR
        • UH Arts

        The small print

        • Terms of use
        • Privacy and cookies
        • Criminal Finances Act 2017
        • Modern Slavery Act 2015
        • Sitemap

        Find/Contact us

        • T: +44 (0)1707 284000
        • E: ask@herts.ac.uk
        • Where to find us
        • Parking
        • hr
        • qaa
        • stonewall
        • AMBA
        • ECU Race Charter
        • disability confident
        • AthenaSwan