Nonobstructive coronary artery myocardial infarction complicated by heart failure, ventricular aneurysm, and incessant ventricular arrhythmia: A case report

RATIONALE: Myocardial infarction with nonobstructive coronary artery (MINOCA) is one of the common causes of cardiac related death. While patients with MINOCA usually do not need coronary artery intervention treatments, the prognosis could be worsened if the condition is not appropriately managed. This report describes a case of MINOCA patient suffered with multiple complications. PATIENT CONCERNS: A 63-year-old female was admitted to the emergency department with acute onset of chest pain, electrocardiogram showed ST segment elevation in precordium leads. DIAGNOSIS: Emergency coronary artery angiogram no significant coronary artery stenosis being observed. The diagnosis of MINOCA was established. She subsequently developed ventricular thrombus, heart failure, and ventricular arrhythmia. INTERVENTIONS: The patient's ventricular tachycardia (VT) was refractory to different treatments. Due to the presence of a ventricular thrombus, epicardial ablation was performed but the VT recurred. The patient was then successfully treated with an implantable cardioverter defibrillator and surgical removal of the ventricular aneurysm. OUTCOMES: The patient was free of events during the 3-month follow-up period after the surgery. LESSONS: MINOCA can occur with multiple complications, and surgical removal of a ventricular aneurysm can successfully recover the cardiac geometry during contraction leading to an improvement of the left ventricular bump function, as well as the removal of the potentially pathological loci of the VT.