January 22, 2020/Heart Health

Can You Have a Heart Attack Without Having Any Blocked Arteries?

The short answer from a preventive cardiologist

Younger woman having chest pain

Q: I recently had a heart attack, but a cardiac catheterization found no blocked arteries. Is this possible?

A: Yes, this type of heart attack is called a myocardial infarction in the absence of obstructive coronary artery disease, or MINOCA. It accounts for 5 to 6% of heart attacks.

Advertisement

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

Compared with other types of heart attacks, patients are usually younger and more likely to be female.

Causes of MINOCA include:

  • Minor plaque build-up is disturbed leading to temporary clotting in your coronary artery.
  • Short-lived (transient) spasm of a large coronary artery.
  • Narrowing of the small blood vessels that branch off the coronary arteries, called microvessel disease or microvascular coronary disease.
  • A spontaneous tear or dissection of the coronary artery.
  • A blood clot or embolism in a coronary artery.

MINOCA is diagnosed based on abnormalities in blood enzymes that show damage to the heart’s muscle. A catheterization will show no evidence of obstruction (blockage) and confirm that no artery is blocked 50% or more. Other imaging tests will identify a limited (localized) area of heart muscle injury.

Cardiac MRI or direct imaging of the interior of your coronary artery may be helpful if the diagnosis is unclear.

You should be evaluated for an increased tendency to form blood clots. It’s important to rule out other causes that may masquerade as a heart attack.

Because MINOCA has a variety of causes, uncovering the correct one is necessary for your doctor to choose the appropriate treatment. These may include calcium channel blockers for spasm or intensive use of blood thinners (anticoagulants) to try to prevent blood clot formation.

The likely course of your disease depends on its underlying cause and treatment strategy.

Ongoing studies are still needed to better understanding the likelihood of recovery from MINOCA. But research suggests that those with MINOCA who receive standard heart attack therapy (aspirin, beta-blockers, ACE inhibitors and statins) have a better long-term outcome than those who don’t.

— Cardiologist Leslie Cho, MD

Advertisement

Learn more about our editorial process.

Related Articles

Older couple talk while leisurely walk across a bridge
February 29, 2024/Heart Health
Can You Exercise After a Heart Attack?

Absolutely! In fact, in many ways, exercise is key to recovery

Person having a heart attack in background, close up of hand calling 911 on cell phone in foreground
February 28, 2024/Heart Health
Can You Stop a Heart Attack Once It Starts?

There’s no way to stop it once a heart attack is happening, but the most important thing you can do is to call for help

person holding hands to upper chest
January 26, 2024/Heart Health
How To Tell the Difference Between a Heart Attack and a Panic Attack

To help determine what you’re experiencing, focus on how the pain feels, the location of the pain, when it started and how long it lasts

close up of bottle of pills spilling onto table
January 24, 2024/Heart Health
Take Your Cholesterol Meds: Stopping Statins Can Cause Dangerous Side Effects

Stopping this critical medication on your own increases the risk of heart attack, stroke and more

A sad couple standing on each side of a large broken heart
December 3, 2023/Heart Health
Yes, You Can Die From a Broken Heart — But No, It’s Not Likely at All

The emotional toll of loss and other strong emotions can have life-threatening physical effects

Person with chest pain and hard to breathe with heart and heartbeat in background.
July 18, 2023/Heart Health
What Does a Heart Attack Feel Like?

Symptoms may be mild, but don’t be fooled — any heart attack is serious

Doctor listens to patient's heart during an office appointment.
April 24, 2023/Heart Health
Early Signs of a Heart Attack To Take Seriously

Subtle heart attack warning signs include pressure, cold sweats and fatigue

woman with chest pain
April 23, 2023/Heart Health
Why Does My Chest Hurt? 3 Signs It Might Not Be a Heart Attack

Not all chest discomfort is a symptom of a heart attack

Trending Topics

Person in yellow tshirt and blue jeans relaxing on green couch in living room reading texts on their phone.
Here’s How Many Calories You Naturally Burn in a Day

Your metabolism may torch 1,300 to 2,000 calories daily with no activity

woman snacking on raisins and nuts
52 Foods High In Iron

Pump up your iron intake with foods like tuna, tofu and turkey

Ad