Myocardial infarction is one of the most common general diseases in the Western world and is usually caused by a blood clot blocking coronary arteries on the surface of the heart. But in up to ten percent of all heart attacks, there is no apparent cause in the coronary arteries. Then patients are diagnosed with MINOCA (Myocardial infarction with unclogged coronary arteriesLater, it can lead to many different diagnoses.
The majority of patients are women and a large portion of this group is diagnosed with takotsubo, also known as broken heart. It is a condition with impaired heart function that may be due to stress and that gives the same symptoms as it does in a normal heart attack.
Associated with psychological stress
Broken heart affects 80-90% of women and is associated with stress. There also appears to be an association with an increased sensitivity to stress due to lower levels of the hormone estrogen. Unfortunately, research is often done on investigating and treating suspected heart attacks in men, while heart disease in women is less specific, says Per Tornfal, chief physician and professor in the Department of Clinical Education and Research, at Södersjökhuset, the Karolinska Institute that led a study.
Cardiac magnetic camera examination is often used in the examination of MINOCA patients. A magnetic camera examination after about ten days of illness can give less than half of patients a diagnosis, usually takotsubo or myocarditis, according to a previous study of 150 patients from the Karolinska Institute. The same researcher has now tested a new, more sensitive magnetic camera technology two to four days after his illness on a similar group of 148 patients with a median age of 58. As a result, up to 77 percent of patients were diagnosed (35 percent were diagnosed with tacotsubo and 17 percent with myocarditis, compared to 19 and 7 percent, respectively, in the first study).
It can make more people get the right treatment
We do not know the effect of the improved magnetic camera technology, but the results indicate that an early examination could mean that more patients receive the correct diagnosis and thus appropriate treatment. The next step is that we will further develop the magnetic camera examination with cardiac pharmacological stress. Then we can examine the smallest vessels, and in this way we hope to find a cause for 23 percent of those who did not receive a diagnosis, says Pauer Tournival.
The study was conducted in close cooperation with the Department of Cardiac Magnetic Resonance Imaging, Clinical Physiology, Karolinska University Hospital with funding from the Swedish Research Council, Stockholm Region and Heart and Lung Foundation.
Co-authors Peder Sörensson, Magnus Lundin and Martin Ugander belong to Karolinska University Hospital, which has a research agreement with Siemens Healthineers regarding magnetic camera examination.
Over the past three years, Jonas Spaak has received personal drawings from AstraZeneca, Vifor Pharma, and Novo Nordisk, all of which are out of the current study.
Early comprehensive cardiac magnetic resonance imaging in patients with myocardial infarction with unclogged coronary arteriesPeder Sorenson, Christina Eckenbach, Magnus Lundin, Stefan Agwal, Ellen Baxofix Brolin, Kenneth Kidal, Christine Siderlund, Olof Kulst, Maria Daniel, Jensen, Shams Yunus Hasan, Laghman Hinarah, Claes Hoffmann-Bang, Patrick Mariet, Nondita Sarkar, Jonas Plumber, Oscar Weinberg, Martin Ogander, Bear Tournival (JACC Cardiovascular Imaging), online April 14, 2021
Per Tornvall, Senior Physician, Professor, Department of Clinical Research and Education, Södersjukhuset, Karolinska Institutet, [email protected]