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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


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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

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