What is the clinical evidence from this study?

Study design: Case Report. Population: Myocardial Infarction With Non-obstructive Coronary Arteries (MINOCA) (n=1). Intervention: Coronary embolism from left atrial appendage thrombus.

What question did this study set out to answer?

This report aims to highlight the diagnostic complexities of MINOCA and the potential role of embolism as an underlying cause.

June 12, 2026Cureus0 citationsOpen Access

Myocardial Infarction With Non-obstructive Coronary Arteries (MINOCA) Revealing Coronary Embolism From Left Atrial Appendage Thrombus in Rheumatic Valvular Atrial Fibrillation

MMMehdi MoujahidMohammed V University HEHafsa ErreguiMohammed V University HFHicham FaliouniMohammed V University

Key Result

Coronary embolism from a left atrial appendage thrombus was identified as the cause of MINOCA in a 50-year-old woman with rheumatic valvular atrial fibrillation.

Key Points

This report aims to highlight the diagnostic complexities of MINOCA and the potential role of embolism as an underlying cause.
Case report of a 50-year-old woman presenting with acute chest pain.
Diagnostic tools included electrocardiography, transthoracic echocardiography, coronary angiography, and transesophageal echocardiography.
Identified underlying valvular disease and a left atrial appendage thrombus.
Confirmed myocardial infarction with elevated troponin levels.
Echocardiography showed moderate mitral stenosis and severe aortic stenosis.
Coronary angiography indicated thrombotic occlusion, supporting the cardioembolic mechanism.

Study Design

Type

Case Report (n=1)

Multicenter

Structured PICO

Population

A 50-year-old woman with a history of rheumatic fever and atrial fibrillation who presented with MINOCA.

Exposure

Anticoagulation with low-molecular-weight heparin (enoxaparin) transitioned to long-term vitamin K antagonist therapy, beta-blocker, and guideline-directed medical treatment.

This case highlights the importance of considering coronary embolism from a left atrial appendage thrombus in patients presenting with MINOCA, particularly those with rheumatic valvular atrial fibrillation.

Limitations

Cardiac magnetic resonance imaging was not performed to formally exclude myocarditis and Takotsubo syndrome.
Intravascular imaging with OCT or IVUS was not performed to rule out occult plaque disruption or spontaneous coronary artery dissection.

Abstract

Myocardial infarction with non-obstructive coronary arteries (MINOCA) represents a diagnostic challenge with multiple underlying mechanisms, including coronary embolism. We report the case of a 50-year-old woman with a history of rheumatic fever who was admitted for acute chest pain. Electrocardiography showed atrial fibrillation with inferolateral ischemic changes, and elevated troponin levels confirmed myocardial infarction. Transthoracic echocardiography revealed moderate mitral stenosis, severe aortic stenosis, and left atrial enlargement. Coronary angiography demonstrated thrombotic occlusion of the second obtuse marginal branch without significant atherosclerotic disease. Transesophageal echocardiography identified a left atrial appendage thrombus, supporting a cardioembolic mechanism. This case emphasizes the importance of considering coronary embolism in MINOCA, particularly in patients with valvular atrial fibrillation, and highlights the role of a structured diagnostic approach in guiding diagnosis and management.

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