Abstract
The clinical syndrome of myocardial infarction with normal coronary arteries has been recognized for many years, with a prevalence of 1 % to 12 % in patients undergoing emergency coronary angiography. Various pathophysiologic mechanisms have been identified. The most common causes are takotsubo cardiomyopathy and myocarditis. However, other mechanisms for an acute coronary syndrome with normal appearing coronary arteries have to be taken into account, such as coronary embolism, coronary artery spasm, myocardial bridging or other anomalies of the coronary arteries, vasculitis, or coagulation disorders. Cardiac magnetic resonance imaging is a valuable diagnostic tool for investigating the underlying cause of myocardial infarction with normal coronary arteries. This technique can clearly differentiate between Takotsubo cardiomyopathy, myocarditis and myocardial ischemia and should be applied in all cases with an otherwise uncertain aetiology in order to avoid overdiagnosing Takotsubo cardiomyopathy.
