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

Figures

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  Figure 1. Electrocardiogram on admission showing atrial fibrillation with ST-segment depression in the inferior (II, III, aVF) and lateral leads (V4–V6), associated with T-wave inversion, consistent with myocardial ischemia

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  Figure 2. Transthoracic echocardiography demonstrating severe aortic stenosis A) Continuous-wave Doppler showing a peak velocity of 4.48 m/s and a mean gradient of 54 mmHg; B) Aortic valve area estimated at 0.87 cm² using the continuity equation.

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  Figure 3. Transthoracic echocardiography findings A) Apical four-chamber view showing left atrial enlargement; B) Parasternal long-axis view demonstrating a calcified aortic valve with restricted opening and left ventricular hypertrophy.

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  Figure 4. Coronary angiography showing thrombotic occlusion of the distal obtuse marginal branch, with otherwise normal coronary arteries A) Left coronary angiography showing distal thrombotic occlusion of the obtuse marginal branch; the arrow indicates the site of occlusion; B) Right coronary angiography showing no significant atherosclerotic disease.

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  Figure 5. Transesophageal echocardiography showing a thrombus within the left atrial appendage The arrow indicates the left atrial appendage thrombus.