Introduction:
Myocardial infarction with nonobstructive coronary artery disease
(MINOCA) is a group of conditions that share common characteristics and
is characterized by the absence of ≥50% stenosis of coronary arteries
and without any evidence of atherosclerotic plaque rupture [1]. A
study conducted by Waller et al. reported that 4% to 7% of all
patients diagnosed with AMI, do not have underlying atherosclerotic
coronary disease on autopsy or angiography [2].
Coronary artery embolism is a rare and important non-atherosclerotic
cause of acute myocardial infarction (AMI), and the first case of AMI
secondary to coronary embolism was reported in 1856 by Rudolf Virchow
and was classified initially as a precipitating factor for type-II MI,
now recognized as one of the cause of MINOCA [3]. Coronary embolism
(CE) is more frequently reported in infective endocarditis patients and
it mainly involves the left main coronary artery system due to flow
characteristics and aortic morphology [4, 5]. CE may also originate
from mural thrombus within the left-sided cardiac chambers, but it has
rarely been reported in the literature [6]. Most cases of coronary
embolism in the literature have been reported secondary to infective
endocarditis, valvular heart diseases, and atrial fibrillation
[7-9]. Here, we are reporting a case of a 74-year-old female, who
had a chronic history of atrial fibrillation on anticoagulation with
questionable compliance and was admitted with sepsis and takotasubo
cardiomyopathy and later developed AMI secondary to coronary embolism to
the left anterior descending artery.