Diagnosing Heart Attack with No Blockage

Cardiologists at NYU Langone Heart are experts at diagnosing a heart attack with no blockage, also known as myocardial infarction with nonobstructive coronary arteries (MINOCA). Our doctors carefully assess your case and determine the underlying cause of the condition using advanced diagnostic tests, one of which is available at only a handful of other medical centers in the United States.

Symptoms of Heart Attack with No Blockage

Symptoms of heart attack with no blockage are the same as those of a typical heart attack: they may include pain in the chest, neck, jawline, upper stomach, or either arm; shortness of breath; nausea; vomiting; extreme fatigue; or a general sense of unease.

Most women and men with heart attack have chest discomfort, but women are slightly less likely than men to experience chest discomfort while experiencing a heart attack. If chest discomfort occurs, it may be painful but might feel like pressure, burning, or aching, and it may not be severe. Women are more likely than men to feel other symptoms during heart attack, such as shortness of breath, nausea, vomiting, or extreme fatigue. There may also be discomfort in the jawline, neck, upper stomach, an arm, or back.

Causes of Heart Attack with No Blockage

Heart attack with no blockage is three times more common among women who have a heart attack than men who have a heart attack. With detailed testing, about 85 percent of women with heart attack with no blockage can get a specific diagnosis that identifies the underlying cause of their heart event. In other cases, the event may not even be a true heart attack, but is an indication of another type of heart problem.

Our doctors work together to determine the underlying cause of heart attack with no blockage to develop a tailored treatment plan.

Cholesterol Plaque

In heart attack with no blockage, cholesterol deposits may not fully block the artery walls but still damage them enough to trigger a heart attack.

Coronary Artery Spasm

A sudden tightening of the muscles within the arteries that carry blood to your heart can narrow the arteries and restrict blood flow. Up to two-thirds of patients with heart attack with no blockage are found to have a pattern of coronary artery spasm. Coronary artery spasm can occur with or without plaque.

Blood Clotting

Clotting in large or small branches of the coronary arteries can disrupt blood flow to the heart. This clotting can happen on its own or in an area of cholesterol buildup.

Other Conditions That Mimic Heart Attack with No Blockage

Some heart conditions can feel like a heart attack, causing similar changes in the blood and on an electrocardiogram, but are not actually a heart attack. Further tests may be needed to identify the condition.

Myocarditis

An inflammation of the heart muscle (myocardium) can reduce the heart’s ability to pump and cause rapid or abnormal heart rhythms. This inflammation is often associated with infections. However, infections can also trigger a true heart attack. 

Nonischemic Cardiomyopathy

Diseases of the heart muscle that are not related to problems with the coronary arteries can enlarge or thicken the heart, which makes it harder for the heart to pump blood.

Hypertrophic Cardiomyopathy

Hypertrophic cardiomyopathy is a genetic condition that causes the wall of the heart, or myocardium, to become abnormally thick. This condition can block blood flow out of the heart, causing symptoms like chest pain, fainting, and irregular heartbeats.

Takotsubo Syndrome

Also known as broken heart syndrome, takotsubo syndrome is usually caused by severe physical or emotional stress. Heart dysfunction can be severe, but it is usually temporary and does not cause permanent damage to the heart.

Heart Attack with No Blockage Diagnostic Tests

NYU Langone offers many advanced diagnostic tests to accurately assess and identify the underlying cause of heart attack with no blockage (MINOCA). 

Cardiac Magnetic Resonance Imaging

A magnetic resonance imaging (MRI) scan helps your doctor visualize damage associated with heart attack with no blockage. Cardiac MRI uses a strong magnet to make highly detailed images of the heart, including its function and any areas of temporary or permanent damage. 

Optical Coherence Tomography and Intravascular Ultrasound

These imaging tests are each performed during a cardiac catheterization. During optical coherence tomography (OCT), light waves are used to take cross-sectional images from the inside of your coronary arteries, helping physicians to see the wall of the artery in greater detail than a standard coronary angiogram provides. During intravascular ultrasound (IVUS), sound waves capture images from inside the artery to assess the artery wall. These images can provide important findings, such as blood clots or plaques that contain cracks, or ruptures. These tests can also find more narrowing in the arteries than may be visualized on a standard angiogram.

Spasm Provocation Test

In this test, the medication acetylcholine is injected into a coronary artery, while real-time imaging reveals how the artery responds. A normal response is for the artery to open further, but people who are susceptible to spasm have narrowing instead. We are one of the few medical centers in the United States to offer this test, which provides important information about vascular function and helps identify the reason for a heart attack with no blockage.