Type 2 Myocardial Infarction — EECC MCQ

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ModerateCoronary Artery DiseaseType 2 Myocardial InfarctionEECC

A 72-year-old man with type 2 diabetes and CKD stage 3a is admitted with sepsis secondary to pneumonia. His troponin T is elevated at 120 ng/L (normal <14 ng/L) and rises to 145 ng/L at 3 hours. ECG shows sinus tachycardia with ST depression in V4-V6. He has no chest pain. Echocardiography shows LVEF 50% with no new wall motion abnormalities. What is the most likely diagnosis?

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Correct answer: B — Type 2 myocardial infarction

This presentation is consistent with Type 2 MI: troponin rise and fall with dynamic ECG changes in the context of an oxygen supply-demand mismatch (sepsis causing tachycardia and hypotension) without evidence of acute plaque disruption. The Fourth Universal Definition of MI distinguishes Type 2 MI from Type 1 (atherothrombotic) and from myocardial injury (troponin rise without ischaemic symptoms or ECG changes). The presence of dynamic ST changes with troponin rise/fall pattern fulfils criteria for MI rather than non-ischaemic myocardial injury. CKD can cause chronic elevation but not a rising pattern with ECG changes.

Reference: ESC (2023): Fourth Universal Definition of Myocardial Infarction; ESC (2023): ACS Guidelines