0:01

This next case is a 65 year old woman with chest pain

0:05

who underwent a coronary angiogram due

0:07

to being a little bit higher risk or intermediate risk,

0:10

and was found to have no significant

0:12

coronary artery disease.

0:14

So a cardiac R was performed to evaluate

0:17

for other potential causes of chest pain

0:21

and using our normal approach, two chamber looks normal,

0:28

four chamber looks normal, three chamber looks normal,

0:36

starting to get into the short axis from base to apex.

0:40

And so far everything is looking very normal.

0:47

Function is gonna be good.

0:49

No significant findings of any thinning

0:51

or regional wall motion abnormalities.

0:53

All key things that we wanna comment on in a case like this

0:56

related to function.

0:58

But then when we get to the LG imaging,

1:02

something a little bit surprising here.

1:06

So moving again from base to apex.

1:09

We can see here in the basal

1:14

to mid really involving portions

1:18

of the antal lateral segment here and infra lateral segment.

1:21

Here we have sub endocardial LGE involving

1:25

roughly 50% of the myocardium kind of extending to here.

1:30

And then as we work our way down even further,

1:34

we see another focus

1:36

of near Transmural lake gadolinium enhancement

1:40

here in the kind of apical anterior segment.

1:43

And then another focus here in the apical inferior segment.

1:47

So this is a person who we know

1:49

has non-obstructive coronary arteries,

1:52

but these findings are consistent

1:55

with myocardial infarction.

1:56

Now, unfortunately, because this patient was not billed

1:59

as an acute myocardial injury case,

2:02

we did not have T two weighted imaging in.

2:05

In this person. It was done as more of a viability

2:07

or infiltrated kind of evaluation.

2:11

But this is certainly appropriate to call this patient

2:15

manca myocardial infarction

2:17

with non-obstructive coronary arteries.

2:19

And it's in multiple territories.

2:21

This is circ territory,

2:22

and this is probably more LED territory.

2:24

These could be embolic infarcts,

2:26

perhaps if she had some event where she showered,

2:29

maybe even related to the coronary angiograms

2:31

can happen from time to time.

2:33

But uh, I think the bottom line here is

2:35

that these findings are consistent

2:37

with myocardial infarction

2:39

and they need to think about potential etiologies,

2:42

whether it be vasospasm, microvascular disease,

2:46

dissection, those sorts of things.

2:48

So you kind of lumped her into the manoa bucket

2:51

and more Workup is often needed in these patients.