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Type 2 MI — RACP Adult Medicine MCQ

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HardCardiologyType 2 MIRACP Adult Medicine

A 75-year-old man with severe aortic stenosis is awaiting TAVI. He develops chest pain and a type 2 MI (demand ischaemia). His troponin is elevated. Coronary angiography shows moderate stenoses but no culprit lesion requiring intervention. What is the most important management principle for type 2 MI?

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Correct answer: D — Address the underlying cause of supply-demand mismatch

Type 2 MI results from oxygen supply-demand mismatch (rather than plaque rupture as in type 1 MI). Common causes include tachyarrhythmia, severe anaemia, hypotension, severe hypertension, and valvular disease. Management focuses on treating the underlying cause (in this case, severe aortic stenosis and proceeding to TAVI). Standard ACS antiplatelet therapy (DAPT) is generally NOT indicated for type 2 MI. The 2025 Australian ACS guideline distinguishes type 1 from type 2 MI management pathways.

Reference: NHF/CSANZ – 2025 – Australian ACS Guideline