From the Guidelines
Yes, type 2 myocardial infarction (MI) can cause electrocardiogram (ECG) changes and chest pain. According to the 2022 ACC/AHA key data elements and definitions for chest pain and acute myocardial infarction 1, type 2 MI is characterized by an imbalance between myocardial oxygen supply and demand, which can lead to symptoms of acute myocardial ischemia, including chest pain, and new ischemic electrocardiographic changes. The criteria for type 2 MI include detection of a rise or fall of cardiac troponin (cTn) concentrations with at least one value above the 99th percentile URL, along with evidence of an imbalance between myocardial oxygen supply and demand unrelated to acute coronary atherothrombosis.
Some key points to consider in type 2 MI include:
- Symptoms of acute myocardial ischemia, such as chest pain or angina-equivalent symptoms
- New ischemic electrocardiographic changes, including ST-segment depression or T-wave inversions
- Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality in a pattern consistent with an ischemic etiology
- The underlying cause of the oxygen supply-demand mismatch, such as severe anemia, hypotension, or respiratory failure, which guides the management approach 1.
Management of type 2 MI focuses on treating the underlying cause of the oxygen supply-demand mismatch, providing supportive care, and addressing any associated conditions, such as coronary artery disease, if present. This approach is supported by the most recent guidelines and evidence, including the 2022 ACC/AHA report 1.
From the Research
Type 2 Myocardial Infarction (MI) and ECG Changes
- Type 2 MI can cause electrocardiogram (ECG) changes, although the ECG findings may be variable and less helpful in defining risk compared to Type 1 MI 2.
- ECG changes in Type 2 MI can include nonspecific changes, which may not always indicate myocardial ischemia 2.
- A study found that increasing ischemic abnormalities in ECGs were associated with increasing rates of major adverse cardiac events (MACE), including Type 1 and Type 2 MI 2.
Type 2 MI and Chest Pain
- Chest pain is a common symptom of Type 2 MI, and it can be a presenting symptom in patients with this condition 3, 2.
- Type 2 MI can cause chest pain due to myocardial ischemia, which occurs when there is a mismatch between oxygen supply and demand in the heart 4.
- A case study reported a patient with Type 2 MI who presented with chest pain and ECG changes, highlighting the importance of considering Type 2 MI in patients with chest pain and ECG abnormalities 5.
Diagnosis of Type 2 MI using ECG
- ECG is an essential tool in the diagnosis of Type 2 MI, and it can help identify patients with myocardial ischemia 2, 4.
- The ECG can show various abnormalities in patients with Type 2 MI, including ST depression, T wave inversion, and nonspecific changes 2, 5.
- Serial ECGs can contribute to the diagnosis of Type 2 MI, especially in patients with chest pain and ECG abnormalities 4, 5.