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Severe Combined Immunodeficiency — RACP Adult Medicine MCQ

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HardInfectious DiseasesSevere Combined ImmunodeficiencyRACP Adult Medicine

A 49-year-old meets criteria for myocardial infarction, but angiography shows no stenosis above 30% and no culprit lesion. Echocardiography is non-diagnostic. What is the most useful next investigation?

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Correct answer: B — Arrange cardiac MRI to distinguish infarction, myocarditis and Takotsubo syndrome

Explanation lettering: D = shown as A · E = shown as B · B = shown as C · A = shown as D · C = shown as E

E is correct. MINOCA is a working diagnosis; cardiac MRI can distinguish infarction from myocarditis and Takotsubo syndrome and directs disease-specific care. A assumes an unproven mechanism. B ignores objective myocardial infarction. C adds procedural risk without tissue characterisation. D cannot identify the underlying myocardial pathology.

Reference: Heart Foundation and CSANZ, Australian acute coronary syndromes guideline 2025: https://www.heartfoundation.org.au/for-professionals/acs-guideline