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. 2021 May 1;41(3):147-152.
doi: 10.1097/HCR.0000000000000550.

Type 2 Myocardial Infarction: CURRENT CONCEPTS AND OUR EXPERIENCE WITH CARDIAC REHABILITATION

Aiman Smer  1 , Ray W Squires, Ahmed Aboeata, Melissa J Bowman, Kasara A Mahlmeister, Jose R Medina-Inojosa, Amanda R Bonikowske, Apurva Patel, Michael Del Core, Mark A Williams
Affiliations

Type 2 Myocardial Infarction: CURRENT CONCEPTS AND OUR EXPERIENCE WITH CARDIAC REHABILITATION

Aiman Smer et al. J Cardiopulm Rehabil Prev. .

Abstract

Background: Type 2 myocardial infarction (T2MI) is commonly encountered in clinical practice, yet little is known about this challenging condition. Outpatient cardiac rehabilitation (CR) is an integral component in the care of patients with MI. However, specific recommendations for CR, information on the feasibility of participation, and outcome measures for patients with T2MI are lacking.

Clinical considerations: The frequency of T2MI is markedly variable and depends on the studied population, disease definition, adjudication process, cardiac troponin assays, and cutoff values used to make the diagnosis of T2MI. Clinically, it is difficult to distinguish T2MI from type 1 MI or myocardial injury. Type 2 myocardial infarction occurs due to myocardial oxygen supply-demand mismatch without acute atherothrombotic plaque disruption and is associated with adverse short- and long-term prognoses. Currently, there are substantial gaps in knowledge regarding T2MI and there are no clear guidelines for the optimal management of these patients.

Summary: In this article, we present important current concepts surrounding T2MI including the definition, pathophysiology, epidemiology, diagnosis, prognosis, and management. We also discuss referral patterns to CR and participation rates and provide our experience with a case series of 17 patients. Very few patients with T2MI are referred to and participate in CR. Our small case series indicated that patients with T2MI respond favorably to CR and that exercise training following standard guidelines appears safe and is well tolerated.

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Conflict of interest statement

The authors declare no conflicts of interest.

References

    1. Benjamin EJ, Muntner P, Alonso A, et al. Heart disease and stroke statistics—2019 update: a report from the American Heart Association. Circulation. 2019;139(10):e56–e528.
    1. Thygesen K, Alpert JS, White HD, Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction. Universal definition of myocardial infarction. Eur Heart J. 2007;28(20):2525–2538.
    1. Morrow DA. Clinicianʼs guide to early rule-out strategies with high-sensitivity cardiac troponin. Circulation. 2017;135(17):1612–1616.
    1. Thygesen K, Alpert JS, Jaffe AS, et al. Fourth universal definition of myocardial infarction (2018). J Am Coll Cardiol. 2018;72(18):2231–2264.
    1. Meigher S, Thode HC, Peacock WF, Bock JL, Gruberg L, Singer AJ. Causes of elevated cardiac troponins in the emergency department and their associated mortality. Acad Emerg Med. 2016;23(11):1267–1273.