{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T11:50:46Z","timestamp":1753876246943,"version":"3.41.2"},"reference-count":11,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2021,7,18]],"date-time":"2021-07-18T00:00:00Z","timestamp":1626566400000},"content-version":"vor","delay-in-days":17,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background\u2003<\/jats:title>\n                  <jats:p>Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a recently described phenomenon where no flow-limiting lesions are noted on coronary angiography in a patient with electrocardiogram changes, elevated cardiac biomarkers, and symptoms suggesting acute myocardial infarction. Patients with MINOCA can also potentially develop structural cardiac defects through ischaemic injury. Therefore, the absence of a flow-limiting lesion on angiography coupled with structural defects (e.g. apical ballooning) can very easily result in a diagnosis of Takotsubo cardiomyopathy (TTC). This can lead to potentially serious consequences since treatment options between TTC and MINOCA are different.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary\u2003<\/jats:title>\n                  <jats:p>We report a case of a patient presenting with features suggestive of TTC but where the final diagnosis was of a MINOCA that induced an apical ventricular septal defect (VSD). Reaching the correct diagnosis proved challenging given that there is no gold standard diagnostic modality for diagnosing MINOCA.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion\u2003<\/jats:title>\n                  <jats:p>Imaging adjuncts played a vital role in both diagnosing the underlying MINOCA as well as revealing and planning closure of the resultant VSD. Cardiovascular magnetic resonance imaging played an instrumental role in establishing the patient\u2019s primary pathology and in planning a remediation of the structural defect. Structural myocardial defects in a patient with a diagnosis of TTC should prompt clinicians to further investigate whether there is an underlying infarct aetiology (MINOCA).<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytab240","type":"journal-article","created":{"date-parts":[[2021,7,18]],"date-time":"2021-07-18T19:39:50Z","timestamp":1626637190000},"source":"Crossref","is-referenced-by-count":0,"title":["MINOCA-induced apical ballooning case report: a diagnostic conundrum"],"prefix":"10.1093","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4197-3178","authenticated-orcid":false,"given":"Moez","family":"Dungarwalla","sequence":"first","affiliation":[{"name":"University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5959-6628","authenticated-orcid":false,"given":"Polyvios","family":"Demetriades","sequence":"additional","affiliation":[{"name":"University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Been","sequence":"additional","affiliation":[{"name":"University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jamal Nasir","family":"Khan","sequence":"additional","affiliation":[{"name":"University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK"},{"name":"University of Warwick, Coventry, CV4 7AL, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,7,18]]},"reference":[{"key":"2021071819394403800_ytab240-B1","doi-asserted-by":"crossref","first-page":"1496","DOI":"10.1016\/j.jacc.2010.11.029","article-title":"Why not just call it tako-tsubo cardiomyopathy","volume":"57","author":"Sharkey","year":"2011","journal-title":"J Am Coll Cardiol"},{"key":"2021071819394403800_ytab240-B2","doi-asserted-by":"crossref","first-page":"2129","DOI":"10.1253\/circj.CJ-14-0859","article-title":"Diagnosis of takotsubo cardiomyopathy","volume":"78","author":"Scantlebury","year":"2014","journal-title":"Circ J"},{"key":"2021071819394403800_ytab240-B3","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1159\/000338814","article-title":"Stress-induced cardiomyopathy in Sweden: evidence for different ethnic predisposition and altered cardio-circulatory status","volume":"122","author":"Schultz","year":"2019","journal-title":"Cardiology"},{"author":"Thiele","key":"2021071819394403800_ytab240-B4"},{"key":"2021071819394403800_ytab240-B5","first-page":"2693062","article-title":"Ventricular septal defect from takotsubo syndrome","volume":"2016","author":"Lu","year":"2016","journal-title":"Case Rep Cardiol"},{"key":"2021071819394403800_ytab240-B6","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1002\/clc.20957","article-title":"Cardiac rupture in takotsubo cardiomyopathy: a systematic review","volume":"34","author":"Kumar","year":"2011","journal-title":"Clin Cardiol"},{"key":"2021071819394403800_ytab240-B7","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1093\/eurheartj\/ehx393","article-title":"ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation","volume":"39","author":"Ibanez","year":"2017","journal-title":"Eur Heart J"},{"key":"2021071819394403800_ytab240-B8","doi-asserted-by":"crossref","first-page":"1204","DOI":"10.1016\/j.jcmg.2016.11.010","article-title":"Myocardial infarction with nonobstructed coronary arteries","volume":"10","author":"Dastidar","year":"2017","journal-title":"JACC Cardiovasc Imaging"},{"key":"2021071819394403800_ytab240-B9","doi-asserted-by":"crossref","first-page":"1973","DOI":"10.1016\/j.jcmg.2018.12.023","article-title":"Prognostic role of CMR and conventional risk factors in myocardial infarction with nonobstructed coronary arteries","volume":"12","author":"Dastidar","year":"2019","journal-title":"JACC Cardiovasc Imaging"},{"key":"2021071819394403800_ytab240-B10","first-page":"143","article-title":"ESC working group position paper on myocardial infarction with non-obstructive coronary arteries","volume":"38","author":"Agewall","year":"2017","journal-title":"Eur Heart J"},{"key":"2021071819394403800_ytab240-B11","doi-asserted-by":"crossref","first-page":"2619","DOI":"10.1016\/j.jcmg.2020.05.045","article-title":"OCT and CMR for the diagnosis of patients presenting with MINOCA and suspected epicardial causes","volume":"13","author":"Gerbaud","year":"2020","journal-title":"JACC Cardiovasc Imaging"}],"container-title":["European Heart Journal - Case Reports"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ehjcr\/article-pdf\/5\/7\/ytab240\/39075398\/ytab240.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ehjcr\/article-pdf\/5\/7\/ytab240\/39075398\/ytab240.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,18]],"date-time":"2021-07-18T19:40:00Z","timestamp":1626637200000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcr\/article\/doi\/10.1093\/ehjcr\/ytab240\/6323503"}},"subtitle":[],"editor":[{"given":"Andre","family":"Dias","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Alberto","family":"Bouzas-Mosquera","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Ali Nazmi","family":"Calik","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Milenko Zoran","family":"Cankovic","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Brett Sydney","family":"Bernstein","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Fabienne","family":"Vervaat","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2021,7,1]]},"references-count":11,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2021,7,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjcr\/ytab240","relation":{},"ISSN":["2514-2119"],"issn-type":[{"type":"electronic","value":"2514-2119"}],"subject":[],"published-other":{"date-parts":[[2021,7,1]]},"published":{"date-parts":[[2021,7,1]]},"article-number":"ytab240"}}