PMID- 31645381 OWN - NLM STAT- MEDLINE DCOM- 20200317 LR - 20211024 IS - 1757-790X (Electronic) IS - 1757-790X (Linking) VI - 12 IP - 10 DP - 2019 Oct 23 TI - Non-ST elevation myocardial infarction, non-obstructive coronary arteries and severe regional microvascular dysfunction in a patient with dilated cardiomyopathy. LID - 10.1136/bcr-2019-231731 [doi] LID - e231731 AB - Cardiac magnetic resonance (CMR) imaging with late gadolinium enhancement (LGE) is a key modality in providing localisation and characterisation of myocardial injury in patients diagnosed with myocardial infarction with non-obstructive coronary arteries (MINOCA). We present a case that demonstrates the unique ability of CMR to provide crucial information in instances of uncertainty. A 71-year-old patient with dilated cardiomyopathy (DCM) presented with symptoms suggestive of acute myocardial infarction. The diagnosis of MINOCA was confirmed following coronary angiography. CMR imaging with LGE confirmed presence of apical infarction. Quantitative myocardial perfusion mapping demonstrated severely reduced blood flow in the non-infarcted septal segments proximal to the distal infarcted territory. The precise aetiology of apical infarction remains uncertain and is likely attributed to coronary plaque rupture. However, concomitant severe regional microvascular dysfunction is also appreciated. This is a recognised, but not well described, phenomenon in DCM and may contribute to repetitive ischaemic injury and disease progression. CI - (c) BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ. FAU - Kite, Thomas A AU - Kite TA AUID- ORCID: 0000-0002-6021-5738 AD - Department of Cardiovascular Sciences and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester, Leicester, UK. FAU - Marrow, Benjamin A AU - Marrow BA AD - Department of Cardiovascular Sciences and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester, Leicester, UK. FAU - Nduwayo, Sarah AU - Nduwayo S AD - Department of Cardiovascular Sciences and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester, Leicester, UK. FAU - McCann, Gerry P AU - McCann GP AD - Department of Cardiovascular Sciences and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester, Leicester, UK. LA - eng PT - Case Reports PT - Journal Article DEP - 20191023 PL - England TA - BMJ Case Rep JT - BMJ case reports JID - 101526291 RN - Coronary Artery Disease, Autosomal Dominant, 1 SB - IM MH - Aged MH - Cardiomyopathy, Dilated/*complications/diagnostic imaging MH - Coronary Angiography MH - Coronary Artery Disease/*complications/diagnostic imaging MH - Coronary Vessels/diagnostic imaging/pathology MH - Electroencephalography MH - Female MH - Humans MH - Myocardial Infarction/*complications/diagnostic imaging PMC - PMC6827742 OTO - NOTNLM OT - heart failure OT - ischaemic heart disease OT - radiology OT - radiology (diagnostics) COIS- Competing interests: None declared. EDAT- 2019/10/28 06:00 MHDA- 2020/03/18 06:00 PMCR- 2021/10/23 CRDT- 2019/10/25 06:00 PHST- 2019/10/25 06:00 [entrez] PHST- 2019/10/28 06:00 [pubmed] PHST- 2020/03/18 06:00 [medline] PHST- 2021/10/23 00:00 [pmc-release] AID - 12/10/e231731 [pii] AID - bcr-2019-231731 [pii] AID - 10.1136/bcr-2019-231731 [doi] PST - epublish SO - BMJ Case Rep. 2019 Oct 23;12(10):e231731. doi: 10.1136/bcr-2019-231731.