MINOCA – Pathophysiological mechanisms

MINOCA (Myocardial Infarction with Non Obstructive Coronary Arteries) – Pathophysiological mechanisms

Various pathophysiological mechanisms have been associated with myocardial infarction with non obstructive coronary arteries (MINOCA). It could be secondary to disorders in the epicardial coronary arteries like rupture of an atherosclerotic plaque, ulceration, erosion or fissuring of a plaque or coronary dissection without complete occlusion of lumen. There could be an imbalance between the myocardial oxygen supply and demand due to coronary arterial spasm or coronary embolism which lyses later and the artery becomes patent. Coronary endothelial dysfunction and coronary microvascular spasm have also been considered as potential mechanisms. Some authors even consider Takotsubo cardiomyopathy as part of the spectrum of MINOCA, though it does not conform to the definition which specifically mentions exclusion of such conditions which are clinically evident.