Physicians should not overlook myocardial infarction as a diagnosis for female patients with symptoms but who show no signs of obstructive coronary artery disease on an angiogram, a study says. The study, published online Sept. 26 in Circulation, found that a rupture or ulceration of cholesterol plaque in a coronary artery is common among these patients. The plaque disruption can lead to the blockage of an artery and cause a heart attack, the study authors said. By the time an angiogram is performed, however, the blood clot can break up, leaving the appearance of a normal or near-normal artery. These women "often are not treated for [myocardial infarction] and are often told that they did not have [a heart attack] based on the finding of open arteries in the angiogram," said lead study author Harmony R. Reynolds, MD. "Primary care physicians need to know that if a patient presents with myocardial infarction and has open arteries, that's still a myocardial infarction, and they still need treatment," said Dr. Reynolds, associate director of the Cardiovascular Clinical Research Center and assistant professor of medicine in the Leon H. Charney Division of Cardiology at NYU Langone Medical Center. Researchers investigated the cause of myocardial infarction in 50 women 18 and older who did not have obstructive coronary artery disease on an angiogram. Forty-two of the women received an intravascular ultrasound shortly after the onset of their symptoms. Within a week, 44 of the 50 women got a cardiac magnetic resonance imaging test. The tests were performed at NYU Langone Medical Center and Bellevue Hospital Center in New York between June 2007 and August 2010. The intravascular ultrasound indicated that 38% of the myocardial infarctions were caused by a plaque rupture or plaque ulceration that could not be seen on an angiogram. The cardiac MRI revealed abnormal myocardial findings in 59% of the patients. Together, the two tests identified abnormalities in 70% of participants. "Myocardial infarction without coronary artery disease that appears to be significant on an angiogram is more common than many people think," Dr. Reynolds said. "Patients and doctors both need to know there is a form of heart attack that can occur in which the arteries are not blocked on an angiogram." The full and original article can be found at: