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Type 2 Myocardial Infarction: Trying to Fit a Square Peg Into a Round Hole?

      Any cardiologist who performs consultative services acknowledges the numerous requests to clarify the significance of an elevated troponin, frequently involving patients who did not present with chest pain. Typical symptoms and ECG changes are often lacking, arguing against an acute coronary syndrome. We are then pressed to provide a diagnosis, and more importantly, to recommend therapy. Is an elevated troponin in a dialysis patient a “Type 2 myocardial infarction” or the newly coined “myocardial injury?”
      • Thygesen K.
      • Alpert J.S.
      • Jaffe A.S.
      • Chaitman B.R.
      • Bax J.J.
      • Morrow D.A.
      • White H.D.
      Fourth Universal Definition of Myocardial Infarction (2018).
      Are aspirin, B-blockers, statins, and stresstesting or cardiac catheterization the appropriate diagnostic and therapeutic approaches? We believe the current classification schema categorizing this heterogenous group of patients is misleading mechanistically, may cause epidemiologic confusion, and implies a set of therapies which may not be useful or may even be harmful.
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      References

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