C43-52 Crushing Chest Pain, Clear Coronaries: A Case of Minoca Implicating Cardiac Syndrome X

Myocardial infarction with nonobstructive coronary arteries (MINOCA) is an increasingly recognized clinical entity, accounting for approximately 5-10% of all myocardial infarctions. Unlike classic acute coronary syndromes caused by atherosclerotic plaque rupture, MINOCA presents with elevated cardiac biomarkers and ischemic symptoms despite angiographically normal or near-normal coronary arteries. The underlying mechanisms are heterogeneous and may include coronary microvascular dysfunction, vasospasm, or systemic metabolic factors. We present the case of a middle-aged female with insulin-dependent diabetes and recent gastric bypass who developed acute chest pain and was ultimately diagnosed with MINOCA, with cardiac syndrome X suspected as the underlying etiology.The patient is a 46-year-old female with a history of insulin dependent diabetes and gastric bypass six months prior to admission who presented for sudden onset of crushing nonradiating substernal chest pain that woke her from sleep. She had never experienced similar symptoms in the past. Troponin was significantly elevated upon admission (4259 mg/mL) and heparin infusion was started and the patient was admitted for acute coronary syndrome. Vitals signs, additional serology, and imaging were unremarkable. Transthoracic echocardiogram was performed and showed normal left ventricular election fraction and grade 1 diastolic function, no wall motion abnormalities or takutsubo cardiomyopathy. The patient was taken for left heart cardiac catheterization which showed normal coronary arteries without any significant stenosis. The patient was diagnosed with myocardial infarction of nonocclusive coronary artery. She was discharged with daily aspirin, clopidogrel, and high dose statin therapy. Upon review of the case with cardiology, cardiac syndrome X was implicated given that underlying metabolic syndrome was a likely comorbidity.Myocardial infarction with nonobstructive coronary arteries (MINOCA) represents a heterogeneous syndrome that poses diagnostic and therapeutic challenges. In this patient, the absence of obstructive coronary disease alongside elevated troponin and ischemic symptoms suggested microvascular dysfunction, consistent with cardiac syndrome X. Recognition of MINOCA is critical, as management strategies differ from traditional acute coronary syndromes and often require a focus on risk factor modification and tailored pharmacotherapy. This case underscores the importance of considering microvascular angina in patients with metabolic comorbidities and highlights the need for ongoing research to optimize treatment approaches. This abstract is funded by: None