EC Paediatrics

Introduction: The diagnosis of myocardial infarction (MI) typically involves cardiac biomarker elevation and evidence of myocardial ischemia. However, a subset of cases, known as myocardial infarction with non-obstructive coronary arteries (MINOCA), poses challenges in diagnosis and management. This study aims to present a case of MINOCA in a young male and discuss its clinical implications.

Case Presentation: a 16-year-old male experienced sudden chest pain radiating to the right arm. Cardiac evaluation revealed ST segment elevation on an electrocardiogram (ECG), leading to admission. Subsequent coronary angiography ruled out obstructive coronary disease. Further assessments indicated probable viral myopericarditis as the cause. The patient's symptoms improved, troponin levels decreased, and cardiac imaging results were normal.

Discussion: MINOCA, characterized by elevated cardiac biomarkers, non-obstructed coronary arteries, and ischemic clinical features, accounts for 6 - 15% of acute myocardial infarction (AMI) cases. This diagnosis is reached by excluding other potential causes of myocardial injury. The case underscores the importance of thorough diagnostic evaluation, including cardiac imaging, viral panels, and troponin monitoring, to differentiate MINOCA from other cardiac and non-cardiac conditions.

Conclusion: MINOCA, although rare in the pediatric population, remains a diagnostic challenge due to its unique presentation. Thorough evaluation is crucial to exclude other causes of myocardial injury and accurately classify the type of MI. Early identification and appropriate management are essential to ensure optimal outcomes in pediatric patients with suspected cardiac causes. Increased awareness and further research are needed to enhance understanding and management of MINOCA in pediatric cardiology practice.

Keywords: Acute; Myocardial; Infarction; Adolescents

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