Myocardial infarction with non-obstructive coronary arteries and newly diagnosed cancer: is there a link? Case report

Although patients can present with classical myocardial infarction (MI) symptoms requiring urgent evaluation, a subset exhibits no significant obstructive lesions on coronary angiography, revealing a distinct clinical entity known as MI with non-obstructive coronary arteries. This report presents a novel case of a 66-year-old woman with MI with non-obstructive coronary arteries and newly diagnosed renal cell carcinoma. We discuss possible pathophysiological mechanisms that may contribute to the coexistence of these conditions, including systemic inflammation, endothelial dysfunction, oxidative stress, hypercoagulability, and coronary vasospasm.

The patient presented with acute chest pain radiating to the left arm, dyspnoea, elevated high-sensitivity troponin I (319–2114 ng/L), and mild ST depressions in V4–V6. Invasive coronary angiography showed no significant changes leading to a diagnosis of MI with non-obstructive coronary arteries. A cardiovascular magnetic resonance was performed and detected local hypokinesis in the inferoseptal and inferior left ventricular walls without a scar. Accidentally, a mass in the left kidney was observed. An abdominal ultrasound and subsequent computed tomography confirmed the diagnosis of renal cell carcinoma in the lower pole of the left kidney without distant metastasis. A multidisciplinary discussion led to a successful laparoscopic nephrectomy and remission.

This clinical case exemplifies the multifaceted nature of clinical presentations and highlights the importance of considering non-cardiac causes in the differential diagnosis of MI with non-obstructive coronary arteries. Shared risk factors, diagnostic complexities, and treatment considerations necessitate a multidisciplinary approach involving cardiology, nephrology, and oncology for optimal patient care.