Type II Myocardial Infarction: Predisposing Factors, Precipitating Elements, and Outcomes

Abstract

Introduction Myocardial infarction (MI) is a subset of the spectrum of the disease known as acute coronary syndrome (ACS), which comprises three distinct entities including unstable angina (UA) and MI with or without ST-segment elevation. However, many clinicians are unaware that MI itself is classified into five types, the most common being type I, followed by type II. Type II MI occurs due to coronary insufficiency not related to acute plaque change in the coronary vasculature. Data available on type II MI is still limited, particularly in the South Asian setting, despite documented poorer outcomes for the same compared to other types. Therefore, we conducted this study as an attempt to outline the predisposing factors, precipitating elements, and possible outcomes of type II MI. Materials and methods This prospective study was conducted at a tertiary care hospital in Kochi, Kerala for 12 months. A total of 59 patients of ages 10-99 years, with a final diagnosis of MI based on the levels of cardiac biomarkers and electrocardiography (ECG), no previous history of coronary angiography, thrombolysis, percutaneous coronary intervention (PCI), and non-ischemic conditions producing elevations in cardiac biomarkers were included in this study. Demographic features, cardiac biomarker levels, comorbidities, precipitating factors, foci of sepsis, and outcomes of type II MI were noted. The mean was calculated for age and cardiac biomarkers. The frequency and percentages were calculated for gender, comorbidities, precipitating factors, foci of sepsis, and the outcomes of type II MI.

Evaluation of the Relation Between Cardiac Biomarkers and Thorax Computed Tomography Findings in Covid-19 Patients

“…One of the most common precipitating factors for type-II myocardial infarction or injury is sepsis, which is originated predominantly from the lower respiratory tract. Anemia, electrolyte imbalance, arrhythmia and hypotension are also among the common factors associated with type-II myocardial infarction or injury [24]. In our study, troponin was elevated in 25 patients.…”

COVID-19 and Acute Myocardial Injury and Infarction: Related Mechanisms and Emerging Challenges

“…13,91,92 Sepsis, primarily originating from the lower respiratory tract, is also a most common precipitating factor for MI type II (coronary insufficiency not related to acute plaque rupture). 93 Importantly, coronary atherosclerosis is a thrombo-inflammatory atherosclerotic disease, 94 and COVID-19 also instigates a thrombo-inflammatory process, and as such, COVID-19-disease-specific mechanisms may well account for the development of ACS, like a cytokine storm, leading to accelerated formation of new coronary plaques and destabilization and rupture of pre-existing plaques caused by hyperinflammation and/or stress together with the initiation and perpetuation of a pro-thrombotic milieu; 1,95,96 furthermore, direct myocardial injury secondary to acute systemic viral infection might also play a role. 90 Importantly, COVID-19 infection is characterized by infiltration of inflammatory cells that cause excessive production of cytokines, proteases, coagulation factors, oxygen radicals and vasoactive molecules leading to endothelial dysfunction and injury, disruption of fibrous cap, initiation of the coagulation cascade leading to a hypercoagulable state and thrombus formation.…”

Acute Coronary Syndrome in the COVID-19 Era—Differences and Dilemmas Compared to the Pre-COVID-19 Era

“…Increased D-dimer values correlate with disease severity and mortality in the first 28 days of illness [ 30 ]. AMI Type 2 arises as a consequence of the disproportion between the availability and consumption of oxygen [ 31 , 32 ]. Hypoxemia resulting from a respiratory infection can lead to a mismatch between oxygen supply and demand, thus leading to AMI [ 33 ].…”