Ddx causes of myocardial ischemia infarction other than atherosclerotic plaque rupture

• Ischemia w/o plaque rupture (“type 2” MI): ↑ demand (eg, ↑ HR), ↓ supply (eg, HoTN). More likely in older, ♀, non-CAD comorbidities (CKD, etc.) (JACC 2021;77:848). Distinguishing from ACS is 󰶻clinical dx; angiography is 󰶻gold standard.

• Nonatherosclerotic coronary artery disease (JACC 2018;72:2231)

Spasm: Prinzmetal’s variant, cocaine-induced (6% of chest pain + cocaine use r/i for MI)

Dissection: spontaneous (vasculitis, CTD, pregnancy), aortic dissection with retrograde extension (usually involving RCA → IMI) or mechanical (PCI, surgery, trauma)

Embolism (Circ 2015;132:241): AF, thrombus/myxoma, endocard., prosth valve thrombosis

Vasculitis: Kawasaki syndrome, Takayasu arteritis, PAN, Churg-Strauss, SLE, RA

Congenital: anomalous origin from aorta or PA, myocardial bridge (intramural segment)

• Direct myocardial injury: myocarditis; Takotsubo/stress CMP; toxic CMP; cardiac contusion