Learning objectives
To describe the usefulness of MRI in patients with acute chest pain and patent coronary arteries To present a diagnostic algorithm in such patients
Background
The main cause of acute chest pain in patients with ECG changes and elevated cardiac enzymes is coronary artery disease. However, some patients have no coronary obstruction on angiography or MDCT, leading to diagnostic uncertainty. There are a number of potential causes of this clinical situation. Cardiac MRI can provide useful information to distinguish between the cardiovascular conditions that result in this diagnostic dilemma.
Imaging findings OR Procedure details
Why cardiac MRI? Cardiac MRI is able to distinguish between different causes of acute pain in patients with unobstructed coronary arteries. Because of its ability to noninvasively assess morpholgy,function, and tissue characteristics in a "one-stop shop" modality, cardiac MRI has become the method of choice in these patients. Which sequences? What should be suspected? The cardiac causes considered in the differential diagnosis of these patients include ischemic disease, myocarditis/perimyocarditis, cardiomyopathies and acute aortic syndrome. Ischemic disease Acute myocardial infarction (AMI) Approximately 6% of patients with...
Conclusion
Cardiac MRI is a non-invasive powerful and clinically relevant tool to distinguish between different cardiovascular aetiologies of acute chest pain in patients with unobstructedcoronary arteries.
Personal Information
Victor Pineda. Radiology department. Hospital Vall d'Hebron.(Barcelona/ES). Xavier Merino-Casabiel. Radiology department. Hospital Vall d'Hebron.(Barcelona/ES) Jose Rodriguez. Cardiology department. Hospital Vall d'Hebron.(Barcelona/ES) Hug Cuellar. Radiology department. Hospital Vall d'Hebron. (Barcelona/ES) Susana Gispert. Radiology department. Hospital Vall d'Hebron.(Barcelona/ES) Rosa Dominguez-Oronoz. Radiology department. Hospital Vall d'Hebron.(Barcelona/ES)
References
1: Maseri A. Chest pain and normal coronary arteries. N Engl J Med. 2000 Aug 17;343(7):511-2. 2: Arai AE. False positive or true positive troponin in patients presenting with chest pain but 'normal' coronary arteries: lessons from cardiac MRI. Eur Heart J. 2007 May;28(10):1175-7. 3: Bellenger NG, Hobson AR, Curzen NP. Non-ST-elevation myocardial infarction: is this an appropriate diagnosis in troponin-positive chest pain, minimal angiographic coronary artery disease, and no myocardial necrosis by contrast-enhanced cardiac magnetic resonance? Am J Cardiol. 2006 Sep 1;98(5):709. 4: Eitel...