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Case Report
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| Calcified nodule as a cause of myocardial infarction with non-obstructive coronary artery disease | ||||||
| Kaitlyn E. Dugan1, Akiko Maehara2, Raymond Y. Kwong3, Asha M. Mahajan1, Harmony R. Reynolds1 | ||||||
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1Cardiovascular Clinical Research Center, Division of Cardiology, NYU School of Medicine, New York, USA.
2Columbia University Medical Center and New York-Presbyterian Hospital, New York, New York Cardiovascular Research Foundation, New York, New York. 3Cardiovascular Divisions, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts. | ||||||
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| How to cite this article |
| Dugan KE, Maehara A, Kwong RY, Mahajan AM, Reynolds H. Calcified nodule as a cause of myocardial infarction with non-obstructive coronary artery disease. Int J Case Rep Images 2016;7(6):388–391. |
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Abstract
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Introduction:
In patients presenting with myocardial infarction (MI), angiography most often reveals obstructive coronary artery disease (CAD) but 5–20% of patients with MI have non-obstructive CAD (MINOCA) at angiography. Calcified nodule has been identified as a cause of MI with obstructive CAD but to date has not been reported as a cause of MINOCA. Intravascular ultrasound (IVUS) may find an underlying cause of MINOCA but has limited sensitivity for calcified nodule. We report a case of calcified nodule in a patient with MINOCA diagnosed by optical coherence tomography (OCT).
Case Report: The patient was a 60-year-old male former smoker with CAD risk factors who presented with one hour of mid-sternal chest pain. Troponin peaked at 1.28 ng/ml. Electrocardiogram of the patient was normal. Coronary angiography showed minimal luminal irregularities. The patient underwent intracoronary OCT. On OCT, thrombus was identified overlying a calcified plaque with protrusion into the right coronary artery lumen. The appearance was characteristic of calcified nodule. Cardiac MRI scan showed hypokinesis in the basal inferoseptal and basal anterior walls without late gadolinium enhancement. The patient was treated with dual antiplatelet therapy (aspirin and clopidogrel) and a high intensity statin. Conclusion: These combined clinical, OCT and CMR findings confirm that calcified nodule is a cause of MINOCA and underscore the utility of intracoronary imaging to determine the pathophysiology of MINOCA. Even without intracoronary imaging, plaque disruption (e.g. plaque rupture, erosion, or calcified nodule) should be considered in cases of MINOCA based on prevalence of at least 35–40% in prior studies. | |
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Keywords:
Calcified nodule, Coronary artery disease, Myocardial infarction non-obstructive CAD, Myocardial infraction, Optical coherence tomography
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Author Contributions
Kaitlyn E. Dugan – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published Akiko Maehara – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published Raymond Y. Kwong – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published Asha M. Mahajan – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published Harmony R. Reynolds – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published |
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Guarantor of submission
The corresponding author is the guarantor of submission. |
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Source of support
None |
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Conflict of interest
Authors declare no conflict of interest. |
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Copyright
© 2016 Kaitlyn E. Dugan et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information. |
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