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Type 2 Perioperative MI — FRCA Final MCQ

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ModeratePerioperative MedicineType 2 Perioperative MIFRCA Final

A 72-year-old man (ASA III) has emergency surgery for a perforated duodenal ulcer. Post-operatively he develops acute pulmonary oedema. His troponin is elevated. An echocardiogram shows new regional wall motion abnormality and an EF of 35%. He is diagnosed with a perioperative type 2 MI. What is the mechanism of a type 2 MI?

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Correct answer: B — Spontaneous coronary artery dissection

Type 2 MI is caused by myocardial oxygen supply-demand mismatch without acute coronary plaque rupture or thrombosis. Common perioperative causes include: tachycardia, hypotension, hypertension, anaemia, hypoxia, and sepsis – all of which increase myocardial oxygen demand or reduce supply. It is the most common type of perioperative MI (more common than type 1 plaque rupture). Management: correct the underlying cause (haemodynamic optimisation, treat sepsis, correct anaemia), cardiology consultation, and secondary prevention. Coronary angiography may not show acute lesions.

Reference: ESC – 2018 – Fourth universal definition of MI; RCOA – 2023 – Perioperative cardiac events