ReviewDiagnostic and Therapeutic Implications of Type 2 Myocardial Infarction: Review and Commentary
Section snippets
Type 1 vs Type 2 MI
Distinguishing patients with type 2 MI from those with type 1 MI often is not difficult. This distinction can be straightforward in many patients but challenging at other times. Patients with type 1 MI usually present with spontaneous symptoms with or without associated ischemic electrocardiographic (ECG) changes and in the absence of a cause for increased myocardial oxygen demand, for example, tachycardia with heart rates in excess of 120 beats per minute or decreased myocardial blood flow,
The Essence of a Type 2 MI
In the most recent publications from the task force, type 2 MI was categorized as a myocardial infarction secondary to an ischemic imbalance between blood supply and myocardial oxygen demand.4, 5 Patients may or may not have atherosclerotic coronary artery disease. Instances of ischemic myocardial injury with necrosis where an imbalance between myocardial oxygen supply or demand occur include coronary endothelial dysfunction, coronary artery spasm, coronary embolism, tachy-/bradyarrhythmias,
Type 2 MI vs Nonischemic Myocardial Injury with Necrosis
Distinguishing type 2 MI from nonischemic myocardial injury with necrosis represents another challenging problem for the clinician. Nonischemic myocardial injuries are common in patients with severe illness, for example, bacteremia secondary to pneumonia. Problems with the diagnosis of type 2 MI usually do not arise in relatively straightforward patients, but rather in complex medical and surgical patients with multiple comorbidities (Table). An example of such a complex patient would be a
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Cited by (103)
The Aged Heart
2022, Emergency Medicine Clinics of North AmericaCitation Excerpt :With respect to the ECG, older adults are more likely to present with a non-ST segment elevation myocardial infarction (NSTEMI) than an ST segment elevation myocardial infarction (STEMI) when having an acute coronary event.35,36 Additionally, older adults are more likely to have chronically elevated baseline levels of cardiac biomarker, which can further challenge EMPs attempting to determine if acute, rather than chronic, pathologic condition exists.35,37 Elevation in brain natriuretic peptide (BNP) has been noted to be more pronounced in older adults with ACS and further predicts worse outcomes suggesting an increased diagnostic value of this marker in older patients.38
Effect of frailty on initiation of statins following incident acute coronary syndromes in patients aged ≥75 years
2021, MaturitasCitation Excerpt :As for limitations, discerning between type 1 (i.e. caused by acute coronary thrombosis) and type 2 myocardial infarction (i.e. myocardial necrosis caused by imbalance between oxygen supply and demand in the absence of acute coronary thrombosis) is not possible from administrative data at this time. Type 2 myocardial infarction, which affects more older than younger people, is a recent and evolving entity for which there is no clear treatment guidelines at this time [39,40]. The non-use of statins in those with type 2 myocardial may be appropriate, and this may attenuate the inverse relationship between frailty and statin initiation.
Coronary Artery Disease: A Key Issue in Type 2 Myocardial Infarction: Systematic Review and Recent Findings
2023, Journal of Clinical MedicineThe Relevance of Implementing the Systematic Screening of Perioperative Myocardial Injury in Noncardiac Surgery Patients
2023, Journal of Clinical Medicine
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