Recommended Citation
Weber G, Disterhaft P, Pampori A, Tilkens B, Jan MF. The Unobstructed Infarct: MINOCA at the Intersection of Hormones and Amphetamines. Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Abstract
Background/Significance:
Myocardial infarction with non-obstructive coronary arteries (MINOCA) represents approximately 6– 8% of all myocardial infarctions and is more common in younger patients and women.
Description:
A 20-year-old woman taking adderall and combined oral contraceptives presented with her second episode of sudden-onset central chest pain at rest. Troponin was elevated, and EKG showed nonspecific ST-T wave changes. Transthoracic echocardiogram demonstrated an ejection fraction of 63% with a small area of hypokinesis in the mid-anterolateral and inferolateral walls. Cardiac MRI suggested a recent myocardial infarction in a diagonal branch territory with active inflammation. Left heart catheterization revealed normal coronary arteries. She was treated with aspirin, clopidogrel, and rosuvastatin. Three months later, repeat MRI showed persistent basal anterior wall hypokinesis with ongoing inflammatory changes. Her repeat echocardiogram demonstrated resolution of wall motion abnormalities. It was recommended she discontinue her combined oral contraception and switch to progesterone only.
Discussion:MINOCA may be triggered by stimulants and hormonal contraceptives, with recurrent chest pain suggesting coronary vasospasm. In this case, coronary angiography demonstrated normal epicardial vessels, while cardiac MRI revealed transmural late gadolinium enhancement in a diagonal branch distribution, supporting an ischemic cause rather than myocarditis. Given the absence of obstructive coronary disease, coronary vasospasm or transient thrombotic occlusion were considered as likely mechanisms of MINOCA. After exploring her medications, two potential triggers emerged. Amphetamine-based stimulants, including adderall, raise catecholamine levels which promotes coronary vasoconstriction and endothelial dysfunction. Additionally, combined estrogen-progestin oral contraceptives are independently associated with increased arterial and venous thrombotic risk. Careful assessment, multimodality imaging, and individualized risk modification—including adjustment of potentially contributory medications—are essential components of management.
Presentation Notes
Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Full Text of Presentation
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Document Type
Poster
Open Access
Available to all.
The Unobstructed Infarct: MINOCA at the Intersection of Hormones and Amphetamines
Background/Significance:
Myocardial infarction with non-obstructive coronary arteries (MINOCA) represents approximately 6– 8% of all myocardial infarctions and is more common in younger patients and women.
Description:
A 20-year-old woman taking adderall and combined oral contraceptives presented with her second episode of sudden-onset central chest pain at rest. Troponin was elevated, and EKG showed nonspecific ST-T wave changes. Transthoracic echocardiogram demonstrated an ejection fraction of 63% with a small area of hypokinesis in the mid-anterolateral and inferolateral walls. Cardiac MRI suggested a recent myocardial infarction in a diagonal branch territory with active inflammation. Left heart catheterization revealed normal coronary arteries. She was treated with aspirin, clopidogrel, and rosuvastatin. Three months later, repeat MRI showed persistent basal anterior wall hypokinesis with ongoing inflammatory changes. Her repeat echocardiogram demonstrated resolution of wall motion abnormalities. It was recommended she discontinue her combined oral contraception and switch to progesterone only.
Discussion:MINOCA may be triggered by stimulants and hormonal contraceptives, with recurrent chest pain suggesting coronary vasospasm. In this case, coronary angiography demonstrated normal epicardial vessels, while cardiac MRI revealed transmural late gadolinium enhancement in a diagonal branch distribution, supporting an ischemic cause rather than myocarditis. Given the absence of obstructive coronary disease, coronary vasospasm or transient thrombotic occlusion were considered as likely mechanisms of MINOCA. After exploring her medications, two potential triggers emerged. Amphetamine-based stimulants, including adderall, raise catecholamine levels which promotes coronary vasoconstriction and endothelial dysfunction. Additionally, combined estrogen-progestin oral contraceptives are independently associated with increased arterial and venous thrombotic risk. Careful assessment, multimodality imaging, and individualized risk modification—including adjustment of potentially contributory medications—are essential components of management.
Affiliations
Aurora St. Luke’s Medical Center