scholarly journals Unusual aetiology of a type 2 myocardial infarction: a case-based review

2021 ◽  
Vol 72 (1) ◽  
pp. 80-87
Author(s):  
David Toma ◽  
Tania-Emima Toma ◽  
Cristina Bologa ◽  
Cătălina Lionte
Keyword(s):  
Myocardial Infarction ◽  
Myocardial Injury ◽  
Cardiovascular Complications ◽  
Acute Poisoning ◽  
Cardiac Monitoring ◽  
Low Molecular Weight ◽  
Excessive Sweating ◽  
Unknown Quantity ◽  
Muscle Fasciculation

Abstract Organophosphate pesticide (OP) poisoning is quite common and can cause cardiovascular complications and even direct myocardial injury. However, no guideline has included an acute poisoning as a potential cause for a type 2 myocardial infarction (MI) so far. Here we present a case of a 61-year-old woman brought by ambulance to emergency department one hour after accidental ingestion of an unknown quantity of a solution she used against flea infestation. The patient presented with dizziness, myosis, excessive sweating, hypersalivation, sphincteric incontinence, muscle fasciculation, tremor of the extremities, pale skin, alcoholic and pesticide breath odour. Even though we had no guidelines to fall back on, we successfully treated the patient with low-molecular-weight heparin, antiplatelets, statin, diltiazem, antidote therapy, and supportive care. Physicians should be aware that OP poisoning can induce type 2 MI as a complication within a few hours since exposure, and emergency management should always include close cardiac monitoring.

scholarly journals Focal ST-segment elevation without coronary occlusion: myocardial infarction with no obstructive coronary atherosclerosis associated with COVID-19—a case report

2021 ◽  
Vol 5 (2) ◽  
Author(s):  
Casey Meizinger ◽  
Bruce Klugherz
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Respiratory Failure ◽  
Coronary Atherosclerosis ◽  
Myocardial Injury ◽  
Cardiovascular Complications ◽  
St Segment Elevation ◽  
St Segment ◽  
Hypoxic Respiratory Failure ◽  
Artery Disease

Abstract Background While it is understood that coronavirus disease 2019 (COVID-19) is primarily complicated by respiratory failure, more data are emerging on the cardiovascular complications of this disease. A subset of COVID-19 patients present with ST-elevations on electrocardiogram (ECG) yet normal coronary angiography, a presentation that can fit criteria for myocardial infarction with no obstructive coronary atherosclerosis (MINOCA). There is little known about non-coronary myocardial injury observed in patients with COVID-19, and we present a case that should encourage further conversation and study of this clinical challenge. Case summary An 86-year-old man presented to our institution with acute hypoxic respiratory failure and an ECG showing anteroseptal ST-segment elevation concerning for myocardial infarction. Mechanic ventilation was initiated prior to presentation, and emergent transthoracic echocardiography reported an ejection fraction of 50–55%, with no significant regional wall motion abnormalities. Next, emergent coronary angiography was performed, and no significant coronary artery disease was detected. The patient tested positive for COVID-19. Despite supportive management in the intensive care unit, the patient passed away. Discussion We present a case of COVID-19 that is likely associated with MINOCA. It is crucial to understand that in COVID-19 patients with signs of myocardial infarction, not all myocardial injury is due to obstructive coronary artery disease. In the case of COVID-19 pathophysiology, it is important to consider the cardiovascular effects of hypoxic respiratory failure, potential myocarditis, and significant systemic inflammation. Continued surveillance and research on the cardiovascular complications of COVID-19 is essential to further elucidate management and prognosis.

scholarly journals The appropriateness of coronary investigation in myocardial injury and type 2 myocardial infarction (ACT-2): A randomized trial design

2019 ◽  
Vol 208 ◽  
pp. 11-20 ◽  
Author(s):  
Kristina Lambrakis ◽  
John K. French ◽  
Ian A. Scott ◽  
Tom Briffa ◽  
David Brieger ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Randomized Trial ◽  
Trial Design ◽  
Myocardial Injury

Abstract 13297: Short-Term Mortality in Patients With Myocardial Injury and Myocardial Infarction Type 1 and Type 2

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Laura Sarkisian ◽  
Lotte Saaby ◽  
Tina S Poulsen ◽  
Oke Gerke ◽  
Axel C Diederichsen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Myocardial Injury ◽  
Troponin I ◽  
Clinical Indication ◽  
Short Term ◽  
Cox Regression Analysis ◽  
Short Term Mortality

Introduction: Troponin elevations occur in a myriad of clinical conditions other than myocardial infarction (MI) and imply a poor prognosis. So far, data comparing the short-term outcome in patients with myocardial injury vs. patients with type 1 or type 2 MI are not available. Methods: Over a 1-year period we prospectively studied hospitalized patients having cardiac troponin I (cTnI) measured on clinical indication. The diagnosis of type 1 and type 2 MI was according to the universal definition involving a rising and/or falling pattern of cTnI values above the decision limit of 30 ng/L. cTnI elevations above this limit in patients without overt myocardial ischemia were defined as myocardial injury. A 1-month follow-up was done with mortality as endpoint. Results: The study covered 1577 consecutive patients with cTnI values >30 ng/L, of whom 360 had a type 1 MI, 119 a type 2 MI and 1089 had myocardial injury. Type 1 MI patients were younger with a median age of 70 (IQR 61-81) yrs, whereas the median ages in type 2 MI and myocardial injury were higher but comparable : 78 (IQR 67-84) vs. 77 (IQR 67-85) yrs. Peak cTnI values, however, were highest in type 1 MI: 3820 (530-19030) ng/L, lower in type 2 MI: 850 (390-3270) ng/L, and smallest in patients with myocardial injury: 90 (50-270) ng/L (p=0.0001). At one-month follow-up 285 patients had died. Mortality in the different subgroups was: 9% (33/360) in type 1 MI, 24% (28/119) in type 2 MI, and 21% (224/1089) in patients with myocardial injury. The results are depicted in the figure (Kaplan-Meier curves, log-rank-test; p-value <0.0001). Multivariate COX regression analysis revealed a Hazard Ratio (95%) of 2.1 (1.2-3.7) for type 2 MI and 1.4 (0.9-2.1) for myocardial injury. Conclusion: The short-term mortality in patients with myocardial injury and type 2 MI is almost identical but higher than in patients with type 1 MI. These prognostic findings imply that the clinical distinction between myocardial injury and type 2 MI may be somewhat artificial.

Understanding cardiac troponin part 1: avoiding troponinitis

2017 ◽  
Vol 35 (2) ◽  
pp. 120-125 ◽  
Author(s):  
Richard Body ◽  
Edward Carlton
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Cardiac Troponin ◽  
Myocardial Injury ◽  
Supply And Demand ◽  
Clinical Context ◽  
Serial Sampling ◽  
Artery Disease

Cardiac troponin (cTn) is a highly specific biomarker of myocardial injury and is central to the diagnosis of acute myocardial infarction (AMI). By itself, however, cTn cannot identify the cause of myocardial injury. ‘Troponinitis’ is the condition that leads clinicians to falsely assign a diagnosis of AMI based only on the fact that a patient has an elevated cTn concentration. There are many causes of myocardial injury other than AMI. Clinicians are required to differentiate myocardial injury caused by AMI from other causes.In part 1 of this series on cTn, we provide a structured overview to help practising clinicians to interpret ‘positive’ cTn results appropriately. There are three core principles. First, when reviewing a cTn result, clinicians must carefully consider the clinical context. Only this can distinguish primary (termed type 1) AMI caused by coronary artery disease from secondary (termed type 2) AMI caused by another condition with an imbalance in the supply and demand of oxygen to the myocardium. Second, clinicians must consider the patient’s baseline condition in order to determine the presence or absence of factors that may predict a chronic cTn elevation. Third, clinicians should routinely use serial sampling to detect a change of cTn that is expected in patients with acute (rather than chronic) myocardial injury. Using these simple principles, clinicians can avoid underdiagnosis and overdiagnosis of AMI.

Causes of Death After Type 2 Myocardial Infarction and Myocardial Injury

2021 ◽  
Vol 78 (4) ◽  
pp. 415-416
Author(s):  
Claire E. Raphael ◽  
Véronique L. Roger ◽  
Yader Sandoval ◽  
Matthew Johnson ◽  
Allan Jaffe ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Myocardial Injury ◽  
Causes Of Death

scholarly journals Treatment and outcomes of type 2 myocardial infarction and myocardial injury compared with type 1 myocardial infarction

2018 ◽  
Vol 29 (1) ◽  
pp. 46-52 ◽  
Author(s):  
Nathaniel R. Smilowitz ◽  
Pritha Subramanyam ◽  
Eugenia Gianos ◽  
Harmony R. Reynolds ◽  
Binita Shah ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Myocardial Injury

scholarly journals Adverse Cardiovascular Effects of Anti-COVID-19 Drugs

2021 ◽  
Vol 12 ◽  
Author(s):  
Dongling Liu ◽  
Xiang Zeng ◽  
Zufeng Ding ◽  
Fenghua Lv ◽  
Jawahar L. Mehta ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Adverse Effects ◽  
Myocardial Injury ◽  
Cardiovascular Effects ◽  
Cardiovascular Complications ◽  
Therapeutic Interventions ◽  
Risk Of Death ◽  
Cardiovascular Comorbidities ◽  
Global Pandemic ◽  
Acute Myocardial Injury

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or COVID-19 infection is the cause of the ongoing global pandemic. Mortality from COVID-19 infection is particularly high in patients with cardiovascular diseases. In addition, COVID-19 patients with preexisting cardiovascular comorbidities have a higher risk of death. Main cardiovascular complications of COVID-19 are myocardial infarction, myocarditis, acute myocardial injury, arrhythmias, heart failure, stroke, and venous thromboembolism. Therapeutic interventions in terms of drugs for COVID-19 have many cardiac adverse effects. Here, we review the relative therapeutic efficacy and adverse effects of anti-COVID-19 drugs.

scholarly journals Risk Estimation in Type 2 Myocardial Infarction and Myocardial Injury: The TARRACO Risk Score

2019 ◽  
Vol 132 (2) ◽  
pp. 217-226 ◽  
Author(s):  
German Cediel ◽  
Yader Sandoval ◽  
Anne Sexter ◽  
Anna Carrasquer ◽  
Maribel González-del-Hoyo ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Risk Score ◽  
Myocardial Injury ◽  
Risk Estimation
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