[Myocardial infarction with healthy coronaries].

No significant coronary artery lesion is seen on an emergent coronary angiogram in 5 to 10% of patients with myocardial infarction. These patients are most often female, younger and with less risk factors for atherosclerotic disease. Causes of myocardial infarction with no significant coronary artery stenosis (MINOCA) include plaque rupture, coronary artery spasm and coronary microvascular lesions. MINOCA is diagnosed using clinical (prolonged chest pain) ECG and biological (rise in troponin) data. A coronary angiogram is mandatory to confirm the absence of significant coronary artery lesion. Endovascular imaging is often performed. Cardiac MRI confirms the diagnosis of myocardial infarction and rules out other causes of prolonged chest pain and rise of troponin such as myocarditis and Takotsubo syndrome. Long term follow-up by a cardiologist is necessary.