Multidiscip Cardio Annal. 2020 July; 11(2):e104397. Published online 2020 July 24. doi: 10.5812/mca.104397. Case Report ST-Segment Elevation Myocardial Infarction with Normal Coronary Arteries Angiography Morteza Motedayen 1 and Hamid Khederlou 2, * 1 Cardiology Department, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran 2 Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran * Corresponding author: Resident of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Tel: +98-9125426158, Email: ham_khed@yahoo.com Received 2020 May 02; Revised 2020 June 10; Accepted 2020 June 21. Abstract Myocardial infarction (MI) is the most frequent cause of ischemic heart death. MI is generally assumed to be due to arterial throm- bosis superimposed on an atherosclerotic plaque in an epicardial coronary artery. Total occlusion of an epicardial coronary artery leads to ST elevation, while non-occlusive lesion leads to ST depression. We hereby have reported a case of ST-segment elevation myocardial infarction with normal coronary arteries angiography. A 35-year-old man presented with typical chest pain, nausea, vomiting and cold sweating. ECG obtained at admission and 30 minutes later revealed sinus tachycardia with ST-segment eleva- tions (> 2 mm) in leads V2-V5. Cardiac biomarkers including creatine phosphokinase (CPK), creatine kinase muscle-brain (CK.MB) and troponin high sensitive were elevated. The standard treatment for MI including pain relief, aspirin, thrombolysis if indicated and beta blockade were begun for the patient. STEMI was confirmed and thus, angiography was performed. Coronary angiography revealed normal coronary arteries without any angiographic evidence of stenosis, coronary artery dissection, embolism, plaque rupture or vasospasm. Keywords: Acute Myocardial Infarction, Normal Coronary Angiography, ST-Segment Elevation 1. Introduction The major inducement of morbidity and mortality is acute coronary syndrome (ACS) in most countries (1-3). ACS is including unstable angina, ST-segment elevation my- ocardial infarction (STEMI), and non-ST-segment elevation myocardial infarction (NSTEMI), and that is a subgroup of coronary heart diseases (4, 5). The most common mortality from ischemic heart dis- ease is acute myocardial infarction, which accounts for two-thirds of mortalities (6). The most common cause of acute myocardial infarction (AMI) is superimposition of the thrombosis on atherosclerotic plaque and as a result, stenosis in an epicardial coronary artery, which disrupts cardiac tissue perfusion and then symptoms appear. Acute myocardial infarction has other reasons such as spasm, coronary artery dissection etc. (7, 8). Acute chest pain is the common complaint of patients that admitted with AMI. Other symptoms these patients is include shortness of breath, cold sweating, nausea, stroke, weakness, dizzi- ness, lethargy, headache and etc. (9). Cardiologists use the electrocardiogram (ECG) and cardiac biomarkers widely for diagnosis, management, and prognosis of AMI, because of its simplicity, safety, easy accessibility, and low cost (10, 11). Complete coro- nary artery occlusion causes elevated ST, whereas non- obstructive lesion leads to ST depression (11). A combina- tion of symptoms, ECG changes, and cardiac biomarkers, such as troponin, creatine phosphokinase (CPK), creatine kinase muscle-brain (CK.MB) is used to diagnose of AMI (8, 12). Coronary angiography provides the first in vivo imag- ing of the coronary arteries and identifies the culprit lesion (13). After verification of AMI based on ECG changes and in- creased cardiac biomarkers, angiography is done to deter- mine the target lesion and extent of stenosis and coronary perfusion (14). 2. Case Presentation A 35-year-old man presented to the emergency depart- ment with 1 hour of acute onset of left-sided chest pain at rest, retrosternal, pressure sensing, and left shoulder ra- diation. He also complained about nausea, vomiting and cold sweating. He reported active tobacco smoking but de- nied other drug abuse that cause cardiac ischemia, includ- ing amphetamines such as cocaine. He has also disclaimed Copyright © 2020, Multidisciplinary Cardiovascular Annals. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.