MINOCA: The Hidden Heart Attack Affecting Women

June 15, 2026

A nurse giving a senior woman a joint exam

When most people think of a heart attack, they picture a blocked artery cutting off blood flow to the heart. But some people – primarily women – can have a heart attack when their arteries are clear and unobstructed.

“This is known as MINOCA, and it often flies under the radar at first, but it’s especially important to consider in a woman who is having heart attack symptoms,” explains Heather Gornik, MD, Director of the University Hospitals Harrington Heart & Vascular Institute Women’s Cardiovascular Center. Dr. Gornik shares what makes this condition unique, and why it’s so often missed.

What Is MINOCA?

MINOCA stands for myocardial infarction with non-obstructive coronary arteries. In simple terms, it’s a heart attack without the blocked arteries that typically cause it. MINOCA accounts for roughly 5-10% of all heart attacks, and women make up approximately 60% of cases. It’s one of the most underrecognized cardiac conditions in women, which makes awareness essential.

“What’s different about MINOCA is the underlying cause of the heart attack,” says Dr. Gornik. “Because the arteries aren’t significantly blocked, we have to look harder to find the answer.”

Other important signs are there: the heart muscle is damaged, and a key protein called troponin rises. But when doctors look at the coronary arteries, they’re less than 50% blocked, and they don’t have the significant plaque and clots that are seen in typical blockages. In these cases, finding out what went wrong with the heart is the key to treatment.

MINOCA and Women: Understanding the Connection

There are several causes of MINOCA, and many of them are more common in women:

Coronary artery spasm, when an artery suddenly tightens and temporarily cuts off blood flow, is one of the leading causes.
Disease in the smaller vessels of the heart, known as microvascular disease, is another.
A tear in the artery wall called spontaneous coronary artery dissection (SCAD) can also cause MINOCA and has been recognized as an important cause of heart attack in younger women, in particular.
Other conditions such as heart muscle inflammation (myocarditis) or a condition called Takotsubo syndrome or stress cardiomyopathy (often referred to as “broken heart syndrome”) can also cause MINCOA.
Hormonal factors are believed to play a role as well, though the full picture is still being studied. “Women’s hearts are different from men’s – not just anatomically, but in how they respond to stress, hormones and inflammation,” says Dr. Gornik. “MINOCA is one of the clearest examples of that.”

Why MINOCA Is Missed

One of the biggest challenges with MINOCA is misdiagnosis. Research has found that most women with MINOCA are initially misdiagnosed, because an angiogram – the imaging test that looks at the arteries around the heart – comes back without showing a significant blockage.

For many patients, clear arteries are treated as the end of the story. They’re told everything looks fine, that their chest pain was probably stress and sent home. But those patients face real risks of another heart attack, heart failure and stroke if the underlying cause goes unidentified and untreated.

“When a patient comes in with chest pain, elevated heart markers (called troponin) that indicate heart muscle damage, and other signs of a heart attack such as an abnormal EKG, a ‘normal’ angiogram should lead to the next question: What caused this?” says Dr. Gornik. “That's where MINOCA patients too often don’t get the right follow-up care.”

What’s more, the experience of having a serious cardiac event dismissed takes a toll psychologically. Many patients describe years of being told their symptoms are stress or something they’re imagining, when in fact something happened to their heart. Getting a diagnosis and a clear treatment plan can be as meaningful to quality of life as it is to heart health.

How MINOCA Is Diagnosed

When an angiogram shows no significant coronary artery blockages, other testing is needed to investigate the cause of MINOCA.

Cardiac MRI has become one of the most important tools to detect it. It can help distinguish between a true heart attack, inflammation of the heart muscle (myocarditis) and stress cardiomyopathy. These conditions can look similar but require very different treatment. “Cardiac MRI is one of the most important tools we have,” says Dr. Gornik. “It can help us pinpoint what’s actually going on so we can treat it appropriately.”

Early evaluation matters. Some of what MRI picks up is time sensitive. The signs of heart injury are most visible early, and certain findings – like tissue swelling – fade over time. This is one reason early, thorough evaluation matters.

For patients with MINOCA caused by SCAD, imaging of the arteries outside of the heart – such as the carotid and renal arteries – can provide clues by finding an underlying condition called fibromuscular dysplasia (FMD), which accounts for about half of SCAD cases.

Personalizing Treatment for a Complex Condition

Because MINOCA has several possible causes, there is no standard treatment and getting the right diagnosis matters. Depending on what’s driving the condition, treatment might include medications to prevent blood clots, cholesterol-lowering drugs, blood pressure medications, medications to relax the coronary arteries and prevent spasm, or drugs to manage symptoms such as chest pain. Lifestyle changes – managing stress, regular physical activity, a heart-healthy diet – are important for most patients as well.

“Because MINOCA isn’t one condition but many, the treatment has to be just as individualized as the diagnosis,” says Dr. Gornik. “What works for one patient may not be right for another.”

What Patients and Families Should Know

If you or someone you love has cardiac symptoms but were told the arteries look fine, or were sent home without a clear diagnosis, MINOCA may be worth asking about. A few important things to keep in mind:

Open arteries do not rule out a real heart attack. Elevated troponin and symptoms of reduced blood flow, even with no significant blockages of the arteries, deserve a thorough workup.
Ask about cardiac MRI. Done in a timely way after a heart event, it can provide important information about the nature and cause of the injury.
If SCAD is suspected, ask about imaging to also check for FMD.
Heart attack symptoms in women don’t always look like the classic picture. Shortness of breath, jaw pain, fatigue, back pain and nausea can all be warning signs beyond the typical chest pain.
Specialized care matters. Centers with expertise in women’s cardiovascular health have access to advanced diagnostics that aren’t available everywhere, but are important in diagnosing MINOCA and other conditions.

“The main message is, trust your body,” says Dr. Gornik. “If you feel something is off and there are even subtle signs that something is, continue to push for answers.”