Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with acute chest pain suggestive of myocardial ischemia. Cardiac biomarkers (troponin) are elevated, meeting the Universal Definition of MI. Coronary angiography reveals no obstructive coronary artery disease (stenosis <50% in major epicardial vessels). Symptoms are consistent with MINOCA (ICD-10: I21.A1). Differential diagnosis includes coronary vasospasm, microvascular dysfunction, plaque disruption, or occult myocarditis.
Clinical Examination Findings
Cardiovascular exam: S1/S2 present, no murmurs, rubs, or gallops. Peripheral pulses are symmetric and full. No signs of congestive heart failure (no JVD, no peripheral edema, lungs clear to auscultation). Hemodynamically stable. ECG shows [ST-segment changes/T-wave inversion/normal sinus rhythm]. Assessment focuses on excluding myocarditis, Takotsubo cardiomyopathy, and coronary microvascular disease.
Treatment Protocol
Management plan: Initiate secondary prevention therapy based on underlying etiology. Standard protocol includes dual antiplatelet therapy (DAPT) or statins as indicated. If vasospasm is suspected, initiate calcium channel blockers. If myocarditis is suspected, consider cardiac MRI and supportive care. Monitor for recurrent ischemic symptoms. Strict blood pressure and lipid control.