Myocardial Infarction with Normal Coronary Artery (MINCA): A sudden death case report in forensic practice

Death attributed to myocardial infarction associated with normal coronary artery is uncommon. It is even rare when the death occurs during an uneventful pregnancy. We report a 29 year-old lady in her first pregnancy at 32 weeks gestation, suddenly collapsed at home and died at the hospital. She was neither known to have significant medical illness nor eventful antenatal records prior to her death. No family history of cardiac rhythm disturbances was noted. The main coronaries were patent but there were foci of fibrosis within the left ventricular wall of the heart. Histopathological examination of the heart showed multiple infarcts of varying ages as well as mature fibrotic scars. No inflammatory signs were detected at autopsy. This case illustrates an extremely rare cause of sudden and unexpected death during pregnancy attributed to myocardial infarction with normal coronary arteries (MINCA). It emphasizes the need for a full autopsy examination in such cases. It also highlights that certain pregnant mothers may show minimal or no symptoms of illness despite the presence of a life-threatening disease.