MINOCA - When a heart attack is not a heart attack
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- čas přidán 26. 07. 2024
- MINOCA : When a heart attack is not a heart attack
The term MINOCA stands for Myocardial infarction with non-obstructive coronary arteries.
Ill try and explain this a bit better by using a case study.
A 50 year old lady was admitted to my hospital with crushing ches tightness. She had an ECG which suggested changes in keeping with a lack of blood getting to the heart. She had a blood test to measure Troponin. Troponins are enzymes released from the heart when the heart has been damaged. In this lady the troponin was found to be elevated. On the basis of these findings we told her that she had suffered a heart attack. She asked me why I felt she had had a heart attack and I explained to her that she had had chest pains and the blood test indicating damage to the heart was elevated and that was all we needed to say that she had had a heart attack. Clearly quite upset, she asked me what would happen next and i said to her that the heart attack was probably caused by a very severe narrowing or even a blockage of one or more of the blood vessels that supplied blood to the heart and the next step would be to do a test called an angiogram to look at her coronary vessels, identify exactly where the narrowings were and fix them. She agreed and we performed an angiogram and we were fully expecting a blockage but interestingly there weren’t any. She had some very minor plaque but certainly nothing that could explain the heart attack and therefore she was discharged with a diagnosis of MINOCA i.e to all intents and purposes she had a heart attack but without significant obstructive disease in her coronaries.
We have known that patients can present with heart attacks in the absence of obstructive coronary disease for over 80 years but the term MINOCA has been adopted for about the past 7-8 years.
MINOCA is not an uncommon diagnosis. Up to 5-15% of all patients who present with heart attacks are found to have unobstructed coronary vessels and therefore diagnosed with MINOCA. The big problem is that as nothing major is found, there is nothing to fix and this leaves the poor patient feeling very perplexed and uncertain about their future.
Whilst traditional heart attacks are seen in older patients and more men than women, MINOCA is seen more often in younger women . Genetics and physiological stress are also risk factors.
Whilst it is reassuring to find that the heart arteries are not obstructed, MINOCA should not be considered a benign diagnosis because the heart has still suffered damage and the areas of damage can cause the heart to become irritable and cause dangerous heart rhythm disturbances. In addition, the heart can still be left weak and of course, the underlying problem can still manifest with another ‘heart attack’ and more damage in the future.
It is important for me to stress that MINOCA is not a complete diagnosis in itself but rather an umbrella term for patients who present like the lady I mentioned earlier did. There are lots of underlying causes that could explain MINOCA and this is why the diagnosis of MINOCA should prompt more detailed and more sophisticated investigation.
The causes can be divided into 3 groups:
Coronary causes
Cardiac Causes
Non-Cardiac Causes
Humanity needs doctor like you. God should give you strength, love and blessings. I always get reliefs by watching your videos. Because I am so anxiously, gone to 30 times ER thinking I had heart attack. My cardiologist says nothing will happen. You are fine. Done all the tests under the sun. But always your videos give more positivity and strength to my mind. Thank you from the bottom of my heart.❤❤❤
You’re such an amazing Cardiologist! I went through something like this 8 years ago. I won’t get into the whole story. I woke up in the middle of the night with crushing chest pain and my right arm felt like it was going to explode. So scary! Got to the hospital. They did an EKG and cardiac lab work. Both were abnormal. The Cardiologist came in and said I was having a heart attack and he was going to do an angiogram. When he was done he told me that I’d had a heart attack with no blockages and Takotsubo Cardiomyopathy. He said he thought the heart attack might have been an allergic reaction to a medication that I was taking. I lived in another state at the time. I’ve since moved to another state, and the Cardiologist that I’m seeing says he thinks it was just the Takotsubo Cardiomyopathy. He doesn’t think I had a heart attack at all. To this day I have no clue what happened. So confusing and frustrating with no answers. I really appreciate you and this amazing video!
What were your Troponin levels ?
@@cherrymetha3185 I can’t remember, it was in 2014. I’ll look and see if I can find a copy of the results from then. Although the Cardiologists that I’ve seen here do not think NSAID medication’s would have caused a heart attack, I haven’t taken an NSAID to this day, because I just don’t want to try it again. I also have Lupus, so it’s a challenge at times not being able to use anti- inflammatory medications.
Your patients must be grateful to have you as their doctor.
I certainly am!
We appreciate you Dr Gupta! This video is so important and needs to be widely shared, as these extra investigations are so often not being done and they should be to save suffering.
As an African American women residing in the USA under the age of 55, this is intriguing to me. Its so stressful living in this country.
Wish I had a doctor like you.
Thanks for a clear, thorough presentation, Doctor!
Excellent video as usual. Thank you
I wish you were in Miami, Fla. Thank you so much for all you do!
Really appreciate your videos because heart pain is scary and it is really nice to have these explanations.
Great overview doctor, thank you.
you are so amazing cardiologist! your hospital and your patients are so very fortunate having you as their cardiologist.
Love your channel mate! Thank you!!!
Thank you so much for taking the time to explain this condition! You are such a blessing to so many 💓 💓💓💓💓💓💓💓💓💓
You are terrific in the way you so calmly educate us. Thank you
Even as a nurse, the manner in which you explained this, has totally ‘unblocked’ my ability to see through a recent myocarditis diagnosis without MI vs with MI. Sir, you are amazing to this old blockhead 👩⚕️ !
My question is why one heart and two testicles..if i needed back up:)
I wonder when chaos theory and a #16 Non clinical toxicology vaccine monograph saying "no cancer or DNA damage testing done" will be called the second coming of stupid like Thalidomide was first.."safe"' ..HHAH ..okay the monograph NEVER says that word nor do Pfrizers lawyers in teh small print
Might have been better if you had one testicle and a brain! Never mind the heart!
@@josephstalin8439 That's not always the case; if you know what I mean...
Excellent explanation, doctor. I just hope all doctors have the same dedication like you. Thanks for the info.
This dude needs the Nobel Peace Prize.
great stuff. Keep them coming!...I mean ...the videos
Good to see you again Dr. thanks so much for all this information as I am a heart disease patient.. God bless you..❤
Ur so good Doctor!I just love how explanatory,and with such calmness,it is enough to calm anybody,by just LISTENING!!thank you,thank you.I am learning everyday..71 this year,and still discover so many things on this u-tube...You are one good thing,I believe!!thank you,again.
As always so informative. Thankyou so much. God bless.
I am watching more and more of your excellent and exceptional videos. I do thank you and have great trust in what you tell us. I’m making notes as I listen to you but am now not as confident of diagnoses I’ve had so far, they seem based on too little evidence. NB The transcript contains a number of inaccuracies e.g. MINOCA is called Manuka which is honey!
Your videos are always so informative and gives clarity. Can you please make a video on what happens to the heart if scar is found. Types of scars and accordingly the treatment, care and prognosis. Also the reasons of persistent forceful heart beats after covid.
Fascinating. So it's benign short term but long term potentially something may occur later.
Never heard of this health condition before. Even lung and post stroke are causes.
This doctor truly is a gift to the world. I place him on the same level as doctor berg and doctor Ken berry.
Thank you so much Dr Sanjay . I really appreciate your expertise , knowledge and kindness 🌺💚
Thank you, so much, for this
I always check your perspectives because I teach physiology to fire allied health professionals and really benefit from these videos. You’re a blessing. Diagnosing a heart attack is serious the point about insisting on more precision is really of great value
Regarding coronaries I know many cases where a lifestyle change especially those involving a plant based no oil diet was able to revert coronary blockages . Have you had the same experience. Again you’re a wonderful instructor. Blessings always. c
Thank you so much for this invaluable information
Really very clear présentation . I am french but it was very easy to undestand , thanks .
You are a brilliant 👏 doctor. GOD bless u.
Thank you ❤
Very interesting, thank you..
The UK is very lucky to have such a professional, logical and experienced cardiologist looking after its people.
Very interesting Thank you Dr Sanjay
This is amazing thankyou i now understand what is going on its such a relief , this is the first that made sense to me in layman terms .
Thankyou Sanjay...I'm learning.... thankyou
We appreciate You more than you will ever know. You would Love Texas~!
Is there any correlation between MINOCA and gastrocardia syndrome? No one will give me a definitive answer!! Thank you for your videos, wish I lived closer. 😕
Thank you for the video. I have variant angina and getting a diagnosis was next to impossible. Three hospital visits and two cardiologists I hope you helping educate brings light to this condition. As a patient it was scary .
I had a heart attack in June of this year and no cause was found, although my GP has since suggested myocarditis. I have lots of medication but have had no Cardiac Rehabilitation as I was told they couldn’t help with an exercise plan etc without knowing the cause. I am still awaiting the result of an MRI scan and will be so relieved if the results are helpful so that I can move on with my life. This video is very interesting and is the most information I have received since June. Thank you so much.
I had a Heart ‘episode ‘ a few years ago ! Chest pain and blood tests showed Enzymes! I had a Stress Echo which showed everything was ok ! They put the Episode down to Exertion in extreme cold ! I wonder if this would be a cause ! Great video as always ! Sending Love and Best Wishes 💫
Had an incident myself while shoveling Snow. I read in a medical journal that the Cold can somehow affect the lungs.Then feel symptoms of heart also.The cardiologist I saw would not do any tests,and was very dismissive.Problem was I received comments from a lay person regarding my apparent discoloration. I was a nurse ,& at the time denial seemed like my best option
Great info doc, how do you spell that tacatsubo ?
You probably will save my life since now I have some good vocabulary to describe my symptoms whenI see the cardiologist for the first time at age 76 female
Very educational video. Earlier this year I presented at hospital with chest pain and after all the standard testing, (elevated troponin) was sent for an angiogram and a cardiac mri. Conclusion was Takotsubo. Just as Dr. Gupta suggested in this video, several months later, a different cardiologist reviewed my angiogram in great detail and it was determined that I had had a Spontaneous Coronary Artery Dissection (SCAD). Needless to say, I was grateful to have had the angiogram reviewed with fresh eyes. Now it would be very beneficial to know whether this should be termed a heart ‘event’ or a heart ‘attack’. ?
Following a bout of what I would describe as cramp in my heart, which became worse when I lay down, my husband called an ambalance. The paramedics performed an ECG and diagnosed a suspected heart attack. At the hospital another ECG was performed and again the diagnosis was that I was having a heart attack. The angiogram showed no blockage. However, the surgeon told me my heart was very enlarged. Nobody mentioned MINOCA and I was left feeling like I'd wasted everyone's time. I am much fitter than I was two years ago when this happened, but I still worry I might have a heart attack.
I'd imagine there has been an increase in MINOCA driven by covid infections and covid vaccinations too, given the associations with myocarditis and increased blood clotting, as one factor in a complex system of causes for this umbrella term.
The best doc I found on the Covid story is Dr JANE RUBY who works with MIKE ADAMS
Excellent reveal … not to be missed - especially their podcast that showcases the “clots” caused by the COVID “Vax” (which they have stated is not a vaccine by the way).
If you want a deep look into the truth of the “Vax” - please check out their podcasts.
Hi doc ~ amazing video.
Do you know anywhere that can arrange a private mri scan for the heart?
I’m convinced I had a heat attack or minoca after a massive panic attack a few years ago, where I had chest pains, but I wasn’t told to go to a and e. Ever since I’ve been terrified of the damage caused
MRI contrastvdye toxic.. do not in.ject! Causes life long health problems.
MRI Gadolinium Toxicity Support Group Online
Dr Sanjay Gupta might be able to arrange it . I believe he has a private practice . I saw his contact details on a website .
good
F age 37. I have been dealing with chest pain upon extertion for over 16mths...since after a "new med was given". I have had 2 Abnormal EKGs, one during stress test, and other in ER visits ,but no raised troponin levels. I currently taking a slow release nitrate plus nitroglycerin and aspirin to help with the pain. My health has declined so much. l since have been labeled with no obstructions on a Coronary CT. They will not do a angiogram based on these findings. Spasms and micro vascular problems have been raised but said they can not be tested. He would do the MRI if he could. But insurance won't cover it yet...after all the other ones. Clots came up in a blood test but was not a concern to cardiologist or the neurologist. Pots has been a concern because of my heart rate but failed the stupid tilt table-test. I have not heard of Pots causing EKG changes or the type of chest pain I have. I miss walking and moving like a young person, I wish they cared as much about my quality of life, they don't believe it will kill me... whatever it is.
Thank you for your videos and integrity it's rare.
Contact Dr.Gupta through York Cardiology and do a phone appointment to get another perspective. I don't know what the cost will be but it will be worth it.
Get a endopat test it chest for endothelial dysfunction/microvascular disease
Nitric oxide foods is best
Seeded watermelon
Beet powder
Melons of any kind
@@jamberry1135 thank you haven't heard of that test
Could you do a video talking about omega 3 fish oil supplements? Are they good or bad ??
This happened to me last week. I’m 62 female. Slight blockage of 30% . So here I am
Have you noticed an increase in these cases, or them occurring in younger age groups, since early ‘21?
Thank you doc! I just got diagnosed with coronary artery aktasia. Can you share some insight into this please!!!
That happened to me after vaccines … 🥺😞😞😞😞 was so so so scary…. I had the angiogram and same as your patient nothing was found … but wow… it was extremely scary, I felt I was gonna die…
Brings up a question for me. Would taking nitroglycerin tablet help in these cases ?
Hi doctor, could you possibly bring this poi t up in a video whenever possible. Ive been diagnosed with high blood pressure in May, now alot of that is attributed to anxiety as I do suffer from that. 6 months latery blood pressure is down to 138/80, I've had a number of ecg's which all came back fine and also echocardiogram which also show nothing, cardiologist has said my heart is extremwly healthy. But the last few months I've been getting this sudden sharp pain that only last for a split second or seconds and then goes, but it is a scary pain and the cardiologist has said it's could be gastro or muscle related rather than the heart, but I'm still getting the pain, I never had an angiogram, could you give me some advice on wear to go next
Plz explain minoca vs inoca i m medical student but not able to figure out inoca
Hello Dr. Gupta, I can’t explain how much your videos mean to me. Last year I was diagnosed with peripheral artery disease by a nurse who came to my house. It was confirmed With an ultrasound and the doctor put me on statins which with a pescatarian diet lowered my LDL to73. I also don’t get cramps in my legs anymore at night. My question is should I ask my PCP for a referral to a heart doctor? I did the test you recommended which was 10 minutes Of fast jumping on my trampoline without pain, but is that enough? Thank you. Aloha
Thank you Dr Gupta. I’m 50 and just experienced this 6 days ago. Your explanation is the best that I’ve heard all week despite being at a top university hospital. I’m grateful that my testing is on track, going down the exploratory list. Thank you, sir!
An MRI scan of heart more beficial an angiogram...cause it can take a 3-D instead of 2-D scan?? .....must look into this, and if ya don't need contrast injection, all the better...Many thanks Dr. Gupta (wish you were my doctor)
How about speaking out in support of Dr Aseem Malhotra? As a fellow cardiologist, you must be witnessing the same effects on the heart caused by the 💉💉
A well known cardiologist in my country said we shd get a Coronary Calcium Score BUT he said this …
“If they come at you with a needle .. SAY NO. … I just want a CC score “
He explained that Angiograms are notoriously *inaccurate*
They show arteries as much narrower than they, in fact, are. Hence the plethora of unnecessary STENTS which are put in (and which can cause very real complications further along)
Many stent operations are physically taxing and costly.
Mind you, the cost to you benefits the doctors and. surgeons, so that is something to ponder. Seriously.
I had a calcium score done. Quick and painless. Costs me US$150. Insurance won't pay for it.
My coronary calcium score was high and really scared me but I passed a stress test easily. I found out that calcium that deposits at right angles to the axis of the vessels is a problem but if it deposits along the axis of the vessel it will not cause blockage. The fact that insurance won’t pay for this test should make a person skeptical of the results. I think it’s of little value.
Would you mind explain difference between MINOCA, ACS and minor attack. What is right treatment for ACS?
Heart health and nitric oxide, interesting piece of information. Histamine, the amine responsible for circulation. Hanna Kroeger's Circu Flow, another two pieces of interesting information for a cardiologist. New Dimensions in Healing with Hanna Kroeger, a video of many interesting facts that would take the practice of a cardiologist to another level of quality of life for his patients. Thank you for being passionate about quality of life.
What about myokardszintigraphie nuclear stress test to diagnose it
I had very elevated troponin levels, but was also given a heart ultrasound to check if there was scaring from a heart attack, which there wasn’t. It turned out to be HCM.
What is HCM🤔
Hypertropic cardiomyopathy
Can anxiety really feel like a heart attack ?
100%
Yes!! I was in a seminar and we we’re dealing with things I did not want to deal with at the time. I had all of the heart attack symptoms so we went to emergency. The did 3 EKG’s with no indication of heart issues. At one point I realized that it was a panic attact😳 I’ve had a few since then but noticed physical signs before and started into square breathing and other techniques to calm myself down. Anxiety is no joke!
@Bio S That's a lie when people say anxiety cannot kill you. they just tell you that to try to calm down. it can lead to death. In my case when I get panic attacks my heart rate reaches 250 beats per minute and blood pressure 240/130 which if sustained would be deadly. The only thing that calms me down is my anxiety meds which I don't like to take. Technically they can't say anxiety or a panic attack would be the CAUSE of death but it can definitely trigger an event that leads to death
@Bio S yes I agree
Absolutely
Reiki, it works! Look it up.
I really don’t know what to do so I’m writing this I’m 21 years old girl.For 7 months my heart beat shakes all of my body. Even my head shakes with my heart beat. I went to cardiologist they done every test but they said there’s nothing wrong with my heart.they gave me propranolol I’ve been taking it regularly everyday but I’m still feeling same my body still shaking with my heartbeat I can’t even sleeping at night because of this its really so annoying. And I also started feeling my pulse in my neck sometimes and my ears started to make sound I don’t know how to explain its like whooshing and pressure.it comes and goes. I literally feel so desperate. My life is like hell for 7 months because of this.
@@user-vx7ef3qt1k I’m sorry to hear this. I really don’t know what to do or what causes this symptoms. I feel so desperate
@@user-vx7ef3qt1k have you seen a doctor? what are they saying about this symptoms?
@@user-vx7ef3qt1k same... I just don’t think its anxiety
@@user-vx7ef3qt1ksame.everyday is a hell for me. And I’m tired of going to doctors. cause the only answer that i get is “its anxiety”
would an mri show past or only recent scaring?
MRI contrast dye is toxic. Do not in.ject dye. Numerous complaints of p0isoning from dye but still FDA wont take it off market.
Yes with contrast enhancement
aged 64...my blood pressure is always around 100/70 at rest and around 75 to 80 beats a minute...however the rhythm is always irregular with missed beats and quick and slow...the doctor says i have Right bundle branch block and afib but 99% of the time i feel ok...the doc wants me to take medications and i said no thanks....should i be worried?
In a way you're lucky you don't feel it as it's like torture when you do.
I think being in AFIB for a long duration increases risk of clots forming and damage to the heart. I'm no doctor though 🤨
@@ShawnTheRazor i eat healthy go swimming every day..i think my fitness helps
@@WillyEckaslike that's great and certainly a plus I would think in your situation.
@@WillyEckaslike Wishing you the best in the future.
This is not helpful. I am a 53 year old woman who was just in the same situation as your case study. I would have to argue that a MINOCA sure sounds like a heart attack to me (part of the heart being without Oxygen). I just got out of the hospital and am still having chest pain; the cardiologist in charge of communicating to me told my family and I that I didn’t have a heart attack and I’m good to go home the 2nd day I was there even though my last troponin was 1800 and it was rising!? So, knowing what I know about heart disease after my dad and his dad and his dad had extensive heart disease and my dad died at age 60 while they were inserting a pacemaker. He said “you are having anxiety so you can stay another night” but what I needed was a better explanation! I believe that now, MINOCA’s are considered heart attacks from the research I have done from reputable hospitals now all call it a heart attack. I believe that there is not enough research into this because it primarily affects women and that is SAD and WRONG. So, I’m sitting here after diagnosis with a d/c troponin of 1333 and continued heart discomfort and expected to just wait for my cardiac MRI to be outpatient “bc insurance won’t cover it if you’re in hospital”- I am disheartened knowing I will always wonder if my daily pressure or discomfort is another heart attack bc ‘ those with MINOCA are more likely to have another heart attack.’ I believe the cardiac physician population and board need to define what is a heart attack? Isn’t it when heart is deprived of oxygen? Why would this one situation be the only situation where you don’t call it a heart attack. Well, my physician the next day (the extra day I was there by choice I guess) told me my diagnosis and said that he never told me or my family I didn’t have a heart attack and changed his mind and told me I had a heart attack but not in the “traditional sense”
Can viruses cause thrombophilia ? You said pneumonia could ...
I had this same experience about four weeks ago. Chest pain, went to hospital and told all looked fine but they would do a second test of troppo in before I went home. My second test came back with elevated troponin so was told I’d had a mild heart attack. Stayed two days to get angiogram and angiogram was fine. Nothing wrong with me. So then I was told I didn’t have a heart attack but I have to take BP pills, statins, and daily aspirin. I asked why? Was told because they didn’t know what had caused my heart attack😵💫. What the hell? I don’t have a heart attack but you have to take these pills because you had a heart attack? I’ve been back to hospital twice since for strange goings on and arrhthmias and no troponin elevation but somethings going on. I suddenly had Afib the last trip to hospital and ive never had that before. So I wonder if some damage has been done to my heart?🤷♀️. I’m thoroughly confused.
Exactly same thing is happening to me.. I had a MINOCA no artery disease, everything is clean but I still have to take statins.. this is confusing. I don't know what to do or what to think. I'm going to do an MRT in 10 days to see if I have damage to my heart.. did you figure something out?
I have just gone through this diagnosis, after a angiogram yesterday. I have been getting heart attack symptoms. My triponon levels have been 0 and ekg is normal. They checked for blockage of the arteries and found no blockage in main arteries and only 50 % or less in a couple of branch arteries. My pains include dull or sharp pains, dizziness, rapid heart beat and shortness of breath, sometimes only 1 at a time and sometimes multiple to all. These happen almost weekly though not always. They have prescribed Norvasc and Zetia to treat. I'm not sure what to do next.
If torponin is zero then it’s not likely a heart attack