Acute myocardial infarction with angiographically normal coronary arteries

The exact etiology of myocardial infarction remains unknown in a majority of the patients with normal coronary arteries. Those who smoke cigarettes and use cocaine are more prone to have this condition. The possible mechanisms underlying myocardial infarction with normal coronary arteries are hypercoagulable states, coronary embolism, an imbalance between oxygen demand and supply, nonatherosclerotic coronary diseases, coronary trauma, coronary vasospasm, and coronary thrombosis. Myocardial infarction with normal coronary arteries primarily affects younger persons and is distinctly rare in patients older than 50 years. We describe a case of acute myocardial infarction with normal coronary arteries in a 61-year-old woman who smoked cigarettes. The clinical perspectives and management of the myocardial infarction with normal coronary arteries are discussed. (Heart Lung® 2000;29:348-50.)