From exercise to emergency-an extreme presentation of MINOCA: a case report.

BACKGROUND: Coronary artery vasospasm (CAS) is an important, yet under-recognized cause of myocardial infarction with non-obstructive coronary arteries (MINOCA), associated with significant morbidity and mortality. CASE SUMMARY: A 51-year-old male presented with an out of hospital ventricular fibrillation (VF) arrest. Coronary angiography with intravascular imaging revealed unobstructed epicardial coronary arteries and cardiac magnetic resonance imaging (CMRi) demonstrated a structurally normal heart with no evidence of fibrosis or myocardial oedema. High-sensitivity troponin I was elevated, confirming acute myocardial injury consistent with a working diagnosis of MINOCA. Subsequent comprehensive coronary function testing (CFT) demonstrated significant spasm fulfilling all three COVADIS diagnostic criteria for definitive epicardial CAS, and timely endotype specific medical therapy was instituted. DISCUSSION: This case highlights the importance of considering CAS in unexplained cardiac arrest. Specific disease endotyping allows a stratified and personalized medical treatment regimen to enhance clinical outcomes and prevent recurrences.