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Type 1 Myocardial Infarction — RACP Adult Medicine MCQ

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EasyCardiologyType 1 Myocardial InfarctionRACP Adult Medicine

A 55-year-old man presents with typical chest pain. Initial troponin I is 15 ng/L (normal). 3-hour troponin rises to 180 ng/L. ECG shows new ST depression in V3-V6. Echo shows new anterolateral hypokinesis. Angiography shows 90% LAD stenosis with ruptured plaque. What is the most likely interpretation?

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Correct answer: C — Acute myocardial infarction (Type 1)

Significant troponin rise (>20% delta) with typical symptoms, ischaemic ECG changes, new wall motion abnormality, and culprit coronary lesion on angiography is Type 1 MI (spontaneous MI due to plaque rupture/erosion). The 4th Universal Definition requires troponin rise/fall above 99th percentile with at least one of: symptoms, ECG changes, imaging evidence, or angiographic evidence.

Reference: CSANZ – 2025 – ACS Guidelines; 4th Universal Definition MI