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Postoperative myocardial injury — SCE Acute Medicine MCQ

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ModeratePerioperative Medicine, End-of-Life Care and Patient SafetyPostoperative myocardial injurySCE Acute Medicine

A 78-year-old man is assessed on the acute medical unit. He is day 2 after emergency laparotomy with anaemia and sepsis. Troponin is elevated and ECG shows diffuse ST depression without STEMI. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most likely underlying cause/mechanism?

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Correct answer: E — Type 2 myocardial infarction from oxygen supply-demand imbalance

Type 2 myocardial infarction from oxygen supply-demand imbalance is the best answer because anaemia, sepsis and tachycardia can cause myocardial oxygen supply-demand imbalance after surgery. Complement-mediated endothelial injury with capillary leak is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Management focuses on correcting triggers and assessing coronary risk.

Reference: Fourth Universal Definition of MI