{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T11:50:01Z","timestamp":1753876201504,"version":"3.41.2"},"reference-count":14,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,4,8]],"date-time":"2025-04-08T00:00:00Z","timestamp":1744070400000},"content-version":"vor","delay-in-days":11,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,3,28]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Myocardial infarction with non-obstructive coronary arteries (MINOCA) affects up to 10% of patients undergoing coronary angiography for acute myocardial infarction. Despite the lack of obstructive lesions, these patients face significant risks, requiring thorough diagnostic evaluations, often using both invasive and non-invasive methods. Recent guidelines emphasize the importance of performing intravascular imaging, coronary functional testing (CFT), and cardiac magnetic resonance (CMR) in the working diagnosis of MINOCA.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>A 48-year-old woman presented with chest pain, elevated cardiac troponins, and signs of non-ST-elevation myocardial infarction. Echocardiography showed normal left ventricular ejection fraction with focal inferior-lateral mid-apical hypokinesia and no significant valvular heart disease. Coronary angiography revealed normal arteries with hypoplasia of the right coronary artery. Further testing, including CMR and CFT with acetylcholine provocation, confirmed severe coronary spasm, diagnosing epicardial vasospastic angina causing MINOCA.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>Diagnosing MINOCA is challenging and requires a multimodal approach. Invasive testing can reveal vasospasm or microvascular dysfunction. This case emphasizes the need for repeated imaging and functional tests to reach a diagnosis. Calcium channel blockers like diltiazem are commonly used in treatment.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytaf173","type":"journal-article","created":{"date-parts":[[2025,4,8]],"date-time":"2025-04-08T19:17:20Z","timestamp":1744139840000},"source":"Crossref","is-referenced-by-count":0,"title":["Unveiling the invisible culprit: a multimodality approach for myocardial infarction with non-obstructive coronary arteries diagnosis\u2014a case report"],"prefix":"10.1093","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4305-3172","authenticated-orcid":false,"given":"Riccardo","family":"Terzi","sequence":"first","affiliation":[{"name":"Division of University Cardiology, IRCCS Ospedale Galeazzi Sant'Ambrogio , Via Cristina Belgioioso 173, 20157 Milan ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7017-778X","authenticated-orcid":false,"given":"Pasquale","family":"Paolisso","sequence":"additional","affiliation":[{"name":"Division of University Cardiology, IRCCS Ospedale Galeazzi Sant'Ambrogio , Via Cristina Belgioioso 173, 20157 Milan ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8815-2865","authenticated-orcid":false,"given":"Francesca","family":"Di Lenarda","sequence":"additional","affiliation":[{"name":"Division of University Cardiology, IRCCS Ospedale Galeazzi Sant'Ambrogio , Via Cristina Belgioioso 173, 20157 Milan ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1443-5788","authenticated-orcid":false,"given":"Edoardo","family":"Conte","sequence":"additional","affiliation":[{"name":"Division of University Cardiology, IRCCS Ospedale Galeazzi Sant'Ambrogio , Via Cristina Belgioioso 173, 20157 Milan ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5519-2818","authenticated-orcid":false,"given":"Emanuele","family":"Gallinoro","sequence":"additional","affiliation":[{"name":"Division of University Cardiology, IRCCS Ospedale Galeazzi Sant'Ambrogio , Via Cristina Belgioioso 173, 20157 Milan ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,4,8]]},"reference":[{"key":"2025042602564579900_ytaf173-B1","doi-asserted-by":"crossref","first-page":"e891","DOI":"10.1161\/CIR.0000000000000670","article-title":"Contemporary diagnosis and management of patients with myocardial infarction in the absence of obstructive coronary artery disease: a scientific statement from the American Heart Association","volume":"139","author":"Tamis-Holland","year":"2019","journal-title":"Circulation"},{"key":"2025042602564579900_ytaf173-B2","first-page":"91","article-title":"Patients with acute myocardial infarction and non-obstructive coronary arteries: safety and prognostic relevance of invasive coronary provocative tests","volume":"39","author":"Montone","year":"2017","journal-title":"Eur Heart J"},{"key":"2025042602564579900_ytaf173-B3","doi-asserted-by":"crossref","first-page":"3720","DOI":"10.1093\/eurheartj\/ehad191","article-title":"2023 ESC guidelines for the management of acute coronary syndromes","volume":"44","author":"Byrne","year":"2023","journal-title":"Eur Heart J"},{"key":"2025042602564579900_ytaf173-B4","doi-asserted-by":"crossref","first-page":"e007880","DOI":"10.1161\/CIRCOUTCOMES.121.007880","article-title":"Survival in patients with suspected myocardial infarction with nonobstructive coronary arteries: a comprehensive systematic review and meta-analysis from the MINOCA global collaboration","volume":"14","author":"Pasupathy","year":"2021","journal-title":"Circ Cardiovasc Qual Outcomes"},{"key":"2025042602564579900_ytaf173-B5","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1093\/ehjacc\/zuad059","article-title":"Sex- and age-related differences in outcomes of patients with acute myocardial infarction: MINOCA vs. MIOCA","volume":"12","author":"Canton","year":"2023","journal-title":"Eur Heart J Acute Cardiovasc Care"},{"key":"2025042602564579900_ytaf173-B6","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.pcad.2023.10.006","article-title":"Characteristics of patients with recurrent acute myocardial infarction after MINOCA","volume":"81","author":"Ciliberti","year":"2023","journal-title":"Prog Cardiovasc Dis"},{"key":"2025042602564579900_ytaf173-B7","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1016\/j.jcmg.2022.12.029","article-title":"Diagnostic and prognostic role of cardiac magnetic resonance in MINOCA","volume":"16","author":"Mileva","year":"2023","journal-title":"JACC Cardiovasc Imaging"},{"key":"2025042602564579900_ytaf173-B8","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/j.jcmg.2023.05.016","article-title":"Prognostic role of early cardiac magnetic resonance in myocardial infarction with nonobstructive coronary arteries","volume":"17","author":"Bergamaschi","year":"2024","journal-title":"JACC Cardiovasc Imaging"},{"key":"2025042602564579900_ytaf173-B9","doi-asserted-by":"crossref","first-page":"ehab724-1490","DOI":"10.1093\/eurheartj\/ehab724.1490","article-title":"Long-term follow-up of patients with MINOCA (myocardial infarction with unobstructed coronary arteries) undergoing intracoronary spasm provocation testing","volume":"42","author":"Pirozzolo","year":"2021","journal-title":"Eur Heart J"},{"key":"2025042602564579900_ytaf173-B10","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1016\/j.jacc.2008.04.050","article-title":"Coronary artery spasm as a frequent cause of acute coronary syndrome","volume":"52","author":"Ong","year":"2008","journal-title":"J Am Coll Cardiol"},{"key":"2025042602564579900_ytaf173-B11","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1161\/CIRCULATIONAHA.114.011201","article-title":"Systematic review of patients presenting with suspected myocardial infarction and nonobstructive coronary arteries","volume":"131","author":"Pasupathy","year":"2015","journal-title":"Circulation"},{"key":"2025042602564579900_ytaf173-B12","doi-asserted-by":"crossref","first-page":"26","DOI":"10.36011\/cpp.2022.4.e6","article-title":"Safety and efficacy of low-dose aspirin in patients with coronary artery spasm: long-term clinical follow-up","volume":"4","author":"Choi","year":"2022","journal-title":"Cardiovasc Prevent Pharmacother"},{"key":"2025042602564579900_ytaf173-B13","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1016\/0002-8703(83)90548-3","article-title":"Effect of aspirin in large doses on attacks of variant angina","volume":"105","author":"Miwa","year":"1983","journal-title":"Am Heart J"},{"key":"2025042602564579900_ytaf173-B14","doi-asserted-by":"crossref","first-page":"e003217","DOI":"10.1161\/JAHA.116.003217","article-title":"Impact of renin-angiotensin system inhibitors on long-term clinical outcomes of patients with coronary artery spasm","volume":"5","author":"Choi","year":"2016","journal-title":"J Am Heart Assoc"}],"container-title":["European Heart Journal - Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjcr\/advance-article-pdf\/doi\/10.1093\/ehjcr\/ytaf173\/62890707\/ytaf173.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/9\/4\/ytaf173\/62890707\/ytaf173.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/9\/4\/ytaf173\/62890707\/ytaf173.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,26]],"date-time":"2025-04-26T06:56:53Z","timestamp":1745650613000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcr\/article\/doi\/10.1093\/ehjcr\/ytaf173\/8108458"}},"subtitle":[],"editor":[{"given":"Andreas","family":"Metzner","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Maayan","family":"Konigstein","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Giorgia","family":"Benzoni","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,3,28]]},"references-count":14,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,3,28]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjcr\/ytaf173","relation":{},"ISSN":["2514-2119"],"issn-type":[{"type":"electronic","value":"2514-2119"}],"subject":[],"published-other":{"date-parts":[[2025,4]]},"published":{"date-parts":[[2025,3,28]]},"article-number":"ytaf173"}}