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Number 07-12: Troponin +ve Chest pain, normal coronaries

 

Case from: Andrew Flett, Mark Westwood, Simon Kennon. Department of cardiology, The Heart Hospital, London, UK and Chase Farm Hospital, London UK.

Clinical: 6 months ago, a 48 year old body builder had troponin positive chest pain with inferior T wave inversion on ECG and normal coronary angiography. Echo had suggested possible inferior hypokinesia. Ongoing clinical uncertainty.

CMR findings:
1.Normal global LV function
2.Minor inferior wall hypokinesia
3.Inferior wall partial thickness late gadolinium enhancement in the distribution of the right coronary artery

Interpretation:
CMR resolved clinical uncertainty in this case of occult MI with normal epicardial arteries. CMR provides a diagnosis in more than 50% of such patients, particularly myocarditis or missed MI. In this case, spontaneous coronary dissection, transient thrombotic occlusion (with or without plaque rupture, but without residual stenosis) or a vasospastic aetiology are possible causes.

Scanner: Siemens Avanto

References:
Bellenger NG ET AL. J Inves Cardio let al; 2006;18:594-8

Assomull RG et al. E Heart J 2007;28:1242-9

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Non-invasive measurement using cardiovascular magnetic resonance of changes in pulmonary artery stiffness with exercise

Forouzan O, Warczytowa J, Wieben O, François CJ and Chesler NCJournal of Cardiovascular Magnetic Resonance 2015, 17:109 (13 December 2015)

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