Perimyocarditis Triggers MINOCA and Sudden Cardiac Arrest in a Healthy Young Man

A previously healthy 37-year-old man presented with chest pain, syncope, and ventricular fibrillation leading to cardiac arrest. He had extensive anterior ST elevations and markedly elevated troponins, but coronary angiography showed non-obstructive arteries, fitting MINOCA. Cardiac MRI demonstrated myocardial edema with non-ischemic late gadolinium enhancement and pericardial involvement, confirming perimyocarditis as the underlying cause. He required ICU support for cardiogenic shock but fully recovered left ventricular function (EF improved from about 32% to 57%) and was discharged on heart-failure therapy and NSAIDs with rehab, underscoring the diagnostic value of early cardiac MRI in MINOCA and the potential for complete recovery with timely treatment.