Diagnostic evaluation of myocardial infarction with non-obstructive coronary arteries in a young patient: suspected coronary embolism from a calcified bicuspid aortic valve

Coronary artery embolism is a relatively infrequent cause of myocardial infarction (MI). This case report presents a case of acute ST-segment elevation MI in the anterolateral wall consistent with suspected coronary embolism originating from a calcified bicuspid aortic valve. Comprehensive coronary angiography revealed no significant findings in the coronary arteries. Transthoracic echocardiogram demonstrated normal left ventricular systolic function accompanied by mid-to-apical anterior and anteroseptal wall akinesia. Notably, severe calcific bicuspid aortic stenosis with moderate aortic regurgitation was also observed. Further cardiac magnetic resonance imaging confirmed nearly transmural myocardial necrosis, myocardial oedema and a substantial region of microvascular obstruction in the proximal left anterior descending (LAD) artery territory, indicating a recent MI in the proximal LAD territory, as well as the presence of an Left ventricular (LV) apical thrombus. Consequently, the patient awaited aortic valve replacement to address the underlying pathology.