Cas du mois Janvier 2023 -Imagerie cardiaque-

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A MINOCA in a patient with a mechanical mitral prosthesis, Myocarditis or STEMI ,how to investigate this patient ?

A H, a 45 years old patient, with a history of bileaflet prosthetic valve in mitral position, was admitted in the cardiology department for inferior STEMI.

The patient had a history of Acenoucoumarol resistance, and was treated with Fluidone, but he had stopped the treatment since 1 month (not available) and he received instead curative doses of enoxaparin.

The TTE showed good parameters of the prothesis (mean gradiant 5 mmHg, no additional images, no leak), LVEF = 45% and an inferior akinesia).

The coronary angiogram showed normal coronaries, the patient refused the TEE exam!

how to investigate this patient in the Tunisian context?

How to investigate this patient in the Tunisian context?