Myocardial Infarction with Angiographically Normal Coronary Arteries in Young People, About One Case: Role of Cardiac Magnetic Resonance Imaging

Myocardial infarction (MI) of the young subject is a particular entity that resides not only in the physiopathology but also in the angiography. Magnetic resonance imaging (MRI) is therefore unavoidable in circumstances where coronary angiography is not very contributive. Rare cases have been described. We report the case of a 29-year-old boy without any cardiovascular risk factor who had a MI with angiographically normal coronary arteries. At admission, the physical examination was unremarkable. Biology showed a positive troponinemia at 24 times the normal. The electrocardiogram recorded a circumferential ST segment elevation, necrosis in inferior and apico-lateral territories, and T-wave inversion in apico-lateral territories. Transthoracic echocardiography (TTE) noted segmental kinetic disorders in the anterior wall with the presence of spontaneous intra-ventricular contrast and reduced left ventricular ejection fraction (LVEF) at 40% (Simpson biplane). Coronary angiography had opacified angiographically healthy coronaries. Cardiac MRI showed late transmural enhancement throughout the apex with the presence of “no reflow” areas suggestive of myocardial infarction. The immediate evolution was favorable under conventional treatment of the MI associated with an anti-vitamin K (acenocoumarol). The follow-up at three (3) months was unremarkable with an improvement in systolic function of the left ventricle at 45% at the Simpson biplane and the disappearance of spontaneous contrast.