CASE REPORT   

Il Giornale Italiano di Radiologia Medica 2018 Luglio-Agosto;5(4):519-22

DOI: 10.23736/S2283-8376.18.00083-9

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: Italian

MRI in patients with acute coronary syndrome and not critical stenosis at coronarography

Cecilia ABATE ¹ ✉, Nicola SFORZA ², Cesare AMICO ³, Annalisa SIMEONE ², Giuseppe GUGLIELMI ^{1, 2}

¹ Dipartimento di Radiologia, Università degli Studi di Foggia, Foggia, Italia; ² Dipartimento di Radiologia, IRCCS Ospedale “Casa Sollievo della Sofferenza”, San Giovanni Rotondo, Foggia, Italia; ³ Dipartimento di Cardiologia, IRCCS Ospedale “Casa Sollievo della Sofferenza”, San Giovanni Rotondo, Foggia, Italia

Myocardial infarction is the first cause of death worldwide. The diagnosis results in the presence of at least two of the three main criteria: typical symptoms, characteristic elevations of cardiac enzymes and electrocardiographic picture with typical evolution and development of Q1 waves. Troponins are very sensitive but remain high only for a few days after the acute event. Many subacute infarcts, therefore, may not be diagnosed. The presence of the Q-wave electrocardiogram allows to recognize up to 60% of silent heart attacks, but Q waves are also present in other cardiopulmonary diseases. On the other hand, the troponin positivity is also present in non-infarct damage conditions, so the guidelines for the diagnosis of infarction involve the use of imaging methods in doubtful cases. In particular, it is usual to perform a coronary angiography, which allows to diagnose the presence of critical vasal structures, equal to or greater than 70%, and at the same time to act therapeutically with angioplasty. In a percentage of patients, however, angiography shows normal coronary arteries and these findings may be present in other diseases, such as myocarditis, Tako-Tsubo syndrome, pulmonary embolism or drug toxicity. Magnetic resonance imaging allows a differential diagnosis with other cardiac diseases, in our case the myocarditis. Here, we describe the case of a patient with acute coronary syndrome and stenosis not critical to coronarography.

KEY WORDS: Acute coronary syndrome - Magnetic resonance imaging - Myocarditis