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Quick Fire Cases

Quick Fire 4- Ischemic Heart Disease II

"Role of Cardiac Magnetic Resonance in Diagnosing MINOCA in Oncology Patients: A Case Report" (QF_SA_114)

Saturday, February 1, 2025
8:50 AM – 9:00 AM East Coast USA Time
Location: Blue Room PreFunction
Description of Clinical Presentation: A 53-year-old male patient was admitted to an Oncology Hospital in São Paulo with a clinical presentation of severe burning chest pain radiating to the left upper limb and jaw. A series of electrocardiograms was performed, revealing dynamic changes in the inferior wall and an initial elevated troponin level (0.024 – reference value 0.016). The patient was given 300 mg of acetylsalicylic acid and a transfer to a tertiary hospital was requested for invasive stratification. The patient had a diagnosis of right testicular seminoma 11 months prior, with recent initiation of oncological treatment including Etoposide and Cisplatin, with the last session administered two days before. A coronary angiography was performed, showing no obstructive lesions. Further diagnostic workup was expanded to investigate myocardial infarction with non-obstructive coronary arteries, including cardiac magnetic resonance imaging. The CMR revealed left ventricular systolic dysfunction with marked hypokinesia in the apical inferior region (ejection fraction 37%) and the presence of late gadolinium enhancement with a transmural ischemic pattern in the apical segment of the left ventricle, with interspersed no-reflow areas and focal myocardial edema. In light of these results, the coronary angiography was reviewed, revealing distal embolization in the anterior descending artery.

Diagnostic Techniques and Their Most Important Findings: Myocardial infarction is one of the leading causes of mortality and morbidity worldwide. Approximately 13.2% of patients with acute coronary syndrome present with coronary arteries without significant obstruction (MINOCA). Although the prognosis in this condition is generally more favorable, it cannot be considered benign. Cardiac magnetic resonance imaging (CMR) is an essential diagnostic tool for identifying the causes of MINOCA, such as acute myocardial infarction with spontaneous recanalization, acute myocarditis, stress-induced cardiomyopathy, and other cardiomyopathies.

Learning Points from this Case: In oncological patients, the etiological assessment of acute coronary syndromes is always a challenge. In this context, CMR plays a crucial role in diagnosing MINOCA, aiding in the appropriate clinical management of patients. The decision regarding exposure to oncological therapy with potential cardiotoxicity in this case was made after the results of the CMR.