The European Society of Cardiology (ESC) has reported criteria for a myocardial infarction with non-obstructive coronary arteries (MINOCA). Once diagnosed the underlying cause needs to be determined. The authors are from multiple institutions in Europe.
In MINOCA coronary arteries show < 50% stenosis.
Causes of MINOCA include:
(1) plaque disruption/rupture/erosion
(2) coronary artery spasm
(3) coronary thromboembolism
(4) coronary dissection, including extension of aortic dissection into coronary arteries
(5) Takotsubo cardiomyopathy
(6) myocarditis
(7) Type 2 AMI (supply-demand mismatch)
Causes of a Type 2 AMI include:
(1) severe anemia
(2) cardiac tachy/brady arrhythmia
(3) respiratory failure
(4) hypotension or shock
(5) severe hypertension
(6) severe aortic valve disease
(7) heart failure
(8) cardiomyopathy
(9) sepsis
(10) toxin or drug (cocaine, methamphetamine, catecholamine)
