ANOCA and MINOCA Heart Conditions

Overview of ANOCA

When blood flow to the heart is reduced, it can cause chest discomfort. Angina with nonobstructive coronary arteries (ANOCA) is a condition where a person experiences chest discomfort, or angina, but no major blood vessel blockages are found. 

Coronary arteries are arranged much like a tree with large branches that feed into smaller branches. These small coronary vessels are referred to as microcirculation. The coronary arteries are dynamic and can change their size or diameter to increase the blood flow to the heart when required.

ANOCA can have a variety of causes including dysfunction in these small coronary vessels, spasms of the small and large coronary vessels, or myocardial bridging where the coronary artery is compressed by the heart muscle. It isn’t uncommon to have multiple causes of angina.

Overview of MINOCA

Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a heart attack the occurs without major blockages to coronary vessels. With MINOCA, there is injury to the heart muscle even though tests, such as angiograms, do not detect significant blockages.

MINOCA can be caused by plaque erosions, spontaneous coronary artery dissection (SCAD)—a sudden tear or split in the coronary artery wall, resulting in blood filling within the tear and blocking blood flow in the artery—a blood clot in small vessels, dysfunction of the small vessels, myocarditis, temporary blood vessel spasm, or or broken heart syndrome—a temporary condition where the heart muscle weakens and becomes enlarged. Symptoms of MINOCA are similar to a heart attack, including an abrupt onset of:

• Chest discomfort (pain, pressure, burning, or tightness)
• Jaw pain
• Unexplained shortness of breath
• Unusual fatigue or weakness
• Unexplained nausea, vomiting or gastrointestinal discomfort
• Cold sweats

Diagnosis

To find the correct treatment of ANOCA and MINOCA, it is important to determine the specific cause. Your physician will typically order a cardiac MRI or coronary function testing which evaluates the function of big and small coronary arteries. Coronary function testing involves several tests, including:

• Inserting a small tube into an artery in the wrist or groin and injecting contrast dye that can be viewed under X-ray.
• Inserting a wire into the heart artery to measure pressure and flow while at rest and with stress induced by medication. The wire can also detect if a myocardial bridge is causing symptoms.
• Administer a medication to test for spasms.
• Perform intravascular ultrasound to look inside your arteries to determine if you have plaque build-up.

Treatment

Common treatments for ANOCA include:

• Medications
• Stress management
• Lifestyle modifications
• Exercise and cardiac rehabilitation

MINOCA is treated like most other heart attacks with medications that lowers the strain on your heart, relaxes coronary vessels, lowers cholesterol, or helps prevent blood clots.

Our team of cardiologists and interventional cardiologists at Saint Luke’s Mid America Heart Institute specializes in diagnosing and treating challenging conditions, such as ANOCA and MINOCA.

Contact Us

To learn more, contact Saint Luke’s Cardiovascular Consultants at 816-931-1883.