Myocardial Infarction With Non-obstructive Coronary Arteries (MINOCA) occurs in up to 10% of patients who have ECG signs of infarction but angiography does not find an occluded vessel. Possible causes include spasm, microvascular dysfunction, thrombophilic states, myocarditis, PE and cardiomyopathies.See also: STEMI Mimics
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This ECG is from a man in his 30s who presented with non-radiating substernal chest pain. He did not have any known medical comorbidities and did not take any medications. On arrival to the Emergency Department he was hypertensive and bradycardic, but alert and ambulatory. Whilst in the ED he had an episode of ventricular fibrillation, was resuscitated and was sent to the cath lab - but his coronary arteries were clear.