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Type 2 myocardial infarction — SCE Acute Medicine MCQ

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HardAcute Cardiac PresentationsType 2 myocardial infarctionSCE Acute Medicine

A 78-year-old woman is assessed on the acute medical unit. She has pneumonia, tachycardia and hypotension. Troponin rises from 44 to 210 ng/L, ECG has no regional ST elevation and echocardiography shows no focal wall-motion abnormality. 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: A — Type 2 myocardial infarction from oxygen supply-demand imbalance

Type 2 myocardial infarction from oxygen supply-demand imbalance is the best answer because sepsis with dynamic troponin rise and no plaque-rupture features is compatible with supply-demand myocardial injury. Acute right ventricular pressure overload 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: Troponin elevation describes injury; the mechanism determines treatment.

Reference: https://www.nice.org.uk/guidance#acute-medicine-order-70-1