| Abstract [eng] |
Background. Although patients can present with classical myocardial infarction symptoms requiring urgent evaluation, a subset exhibits no significant obstructive lesions on coronary angiography, revealing a distinct clinical entity known as myocardial infarction with non–obstructive coronary arteries. This report presents a novel case of a 66–year–old woman highlighting the coexisting myocardial infarction with non–obstructive coronary arteries and newly diagnosed renal cell carcinoma. We provide an in–depth analysis of potential pathophysiological links between these two conditions, emphasizing systemic inflammation, endothelial dysfunction, oxidative stress, hypercoagulability, and coronary vasospasm. Materials and Methods. A review of the scientific literature was conducted using the international database PubMed, the specialized information search system Google Scholar, and the guidelines of the European Society of Cardiology. The search was performed using the following keywords: “myocardial infarction with nonobstructive coronary arteries,” “renal cell carcinoma,” “multidisciplinary approach“, “cardiovascular magnetic resonance.” A clinical case was analyzed and special attention is given to exploring the possible relationship between these two pathologies and the importance of a multidisciplinary team of specialists. Clinical case description. The patient presented with acute chest pain radiating to the left arm, dyspnoea, elevated high–sensitivity troponin I (319 ng/l to 2114 ng/l), and mild ST depressions in V4–V6. Invasive coronary angiography showed no significant changes leading to a diagnosis of myocardial infarction 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. Discussion, Conclusions and Recommendations. This clinical case exemplifies the multifaceted nature of clinical presentations and highlights the importance of considering non–cardiac causes, such as newly diagnosed renal cancer, in the differential diagnosis of myocardial infarction with non–obstructive coronary arteries. The coexistence of myocardial infarction with non–obstructive coronary arteries and malignancy emphasizes similar pathological mechanism, shared risk factors, diagnostic complexities, and unique treatment considerations. A comprehensive multidisciplinary approach involving cardiology, nephrology, and oncology is essential for optimal patient management. Early utilization of advanced cardiac imaging techniques, such as cardiac magnetic resonance imaging, can help clarify etiology and potentially reveal extracardiac abnormalities. Further research may facilitate early diagnosis and enhance clinical outcomes, contributing to better prognoses for patients affected by this challenging clinical combination. |
