Diagnostic Dilemma: Commotio Cordis, Takotsubo Syndrome or MI with Non-obstructive Coronary Arteries? A Case Report

MI with non-obstructive coronary arteries (MINOCA) is an umbrella term that has diverse aetiologies. This case report features a patient with MINOCA after sudden cardiac arrest, highlighting associated diagnostic and therapeutic challenges. It illustrates a stepwise approach to MINOCA evaluation and how the working diagnosis can change with every additional investigation modality. The patient was a 52-year-old man who had VF after a road traffic accident and invasive coronary angiography revealed non-obstructive disease. The eventual diagnosis of MI was confirmed by cardiac MRI. He was treated for presumptive coronary vasospasm and coronary thromboembolism. He had an ICD implanted before he was discharged from hospital and there were no further arrhythmic events. While cardiac MRI is integral to the evaluation of MINOCA, intravascular imaging and provocation testing can further refine the diagnosis and guide treatment in this challenging population.