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Type 2 myocardial infarction — SCE Acute Medicine MCQ

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ModerateAcute Cardiac PresentationsType 2 myocardial infarctionSCE Acute Medicine

A 45-year-old woman presents with acute chest symptoms with haemodynamic concern. Relevant history includes cardiovascular risk factors or structural heart disease. On assessment, haemodynamic findings and ECG changes are present. Investigations show troponin rise occurs during septic shock without regional wall motion abnormality. What is the most likely underlying cause/mechanism?

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Reveal the answer and explanation

Correct answer: B — Myocardial oxygen supply-demand mismatch

The key discriminator is that troponin rise occurs during septic shock without regional wall motion abnormality, which makes Myocardial oxygen supply-demand mismatch the single best answer. Adrenal steroid deficiency is less appropriate because it does not address the dominant acute risk in the vignette; Tissue hypoperfusion causing lactic acidosis would fit a different presentation or later stage of care. Defective neuromuscular transmission and Portal hypertensive bleeding are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: https://www.nice.org.uk/guidance/ng185#acute-medicine-order-34-1