Dilemma of myocardial infarction with angiographically normal coronary arteries: a review

ABSTRACT

In a small number of patients, Myocardial Infarction [MI] is not associated with Coronary Artery Disease [CAD] and normal coronary arteries are documented on angiography. The reasons for this paradox are varied. Thrombosis, embolism and vasospasm are believed to be the mechanisms of ischemia and infarction in these cases. Intravascular thrombosis can result from hematological disturbances as in protein S deficiency and progestational states in females. Coronary embolism has been reported with prosthetic and abnormal valves, endocarditis and cardiac arrythmias. Vasospasm is an important mechanism in cocaine and amphetamine induced infarction. Clinically, these patients are younger and have minimal of the classical risk factors for CAD except cigarette smoking, which has been hypothesized to play a role in pathogenesis. In addition, they do not have any angina before or after the infarct. They have a relatively better prognosis and tend to fare better than similar MI patients with CAD. Management should not differ in the acute phase but calcium channel blockers may have a role