Diagnostics and management of patients with type 2 myocardial infarction

Myocardial infarction (MI) is an acute myocardial injury (confirmed by increasing|decreasing of cardiac troponin T and/or I) in conditions of proven acute myocardial ischemia, manifested by clinical symptoms of acute ischemia and/or ischemic changes on the ECG. Type 2 MI is a form of MI that is not associated with coronary atherothrombosis, secondary to a condition that results in an imbalance between myocardial oxygen intake and oxygen consumption. Type 2 MI can be caused by coronary artery spasm, coronary microvascular dysfunction, embolism, dissection of coronary arteries, aorta, bradyarrhythmia, tachyarrhythmia, respiratory failure with severe hypoxemia, anemia, blood loss, hypotension/shock of other etiology, severe hypertension, surgical interventions. Type 2 MI accounts for 2–70% of all cases of MI. More often type 2 MI occurs in women, elderly, severe, comorbid patients. Type 2 MI is ST segment elevation MI in 3–24% of patients and non-ST elevation MI in others. Coronary angiography (and autopsy) in type 2 MI reveals coronary atherosclerosis in 25–90%, but there is no coronary artery thrombosis. Mortality in patients with type 2 MI is generally higher than in patients with type 1 MI. This article is devoted to the problem of diagnosis and management of patients with type 2 myocardial infarction.