Thread by @JACCJournals

(1/10) #JACC #Tweetorial: T2MI is #cvMI due to alterations in either myocardial oxygen supply and/or demand in the absence of acute atherothrombosis. It can occur in pts w/ normal coronaries and in obstructive/non-obstructive stable #cvCAD. fal.cn/AGvR

(2/10) #JACC #Tweetorial: Frequency of T2MI varies widely due to differences in populations, comorbidities, adjudication processes, & cTN assays, w/ a major challenge being the absence of uniform definitions that can be useful w/ high reproducibility. fal.cn/AGvR

(3/10) #JACC #Tweetorial: How T2MI manifests depends on the pathobiology & clinical context, w/ T2MIs less likely to have chest pain, imaging/#ECG abnormalities & ⬇ cardiac troponin concentrations compared to T1MI. Many T2MIs are driven by other illness. fal.cn/AGvR

(4/10) #JACC #Tweetorial: Are all T2MIs secondary to other illness or processes? Some are present due to coronary etiologies, such as spasm, embolism, spontaneous coronary artery dissection and endothelial dysfunction, or w/ aortic dissection. fal.cn/AGvR #cvMI

(5/10) #JACC #Tweetorial: T2MI diagnosis requires

1️⃣: ⬆ or ⬇ cTn with ≥ value > 99th percentile
2️⃣: Clinical evidence of myocardial ischemia in the absence of acute atherothrombosis. fal.cn/AGvR #cvAMI

(6/10) #JACC #Tweetorial: In the absence of myocardial ischemia, numerous conditions can lead to #troponin ⬆ including direct drug-toxicity & cardioversion. Conceptually, myocardial injury (acute or chronic) = isolated troponin ⬆ w/o myocardial ischemia fal.cn/AGvR

(7/10) #JACC #Tweetorial: 1st steps for T2MI diagnosis include careful H&P, serial #troponin & 12-lead #ECG. When signs are unclear, emphasis should be placed on finding objective evidence of myocardial ischemia (ex. cardiac imaging). fal.cn/AGvR

(8/10) #JACC #Tweetorial: What is the prognosis of T2MI? Patients w/ T2MI have ⬆ risk for CV mortality & MACE, w/ similar or higher all-cause mortality than T1MI. 24-43% die from CV causes, suggesting opportunities to improve outcomes during follow up. fal.cn/AGvR

(9/10) #JACC #Tweetorial: Unlike T1MI, a uniform pathophysiological entity for which management guidelines exist, for T2MI, evidence is lacking. Recognizing the heterogeneous mechanisms leading to T2MI, a phenotype-specific approach is endorsed. fal.cn/AGvR #cvMI

(10/10) #JACC #Tweetorial: Numerous challenges/opportunities exist related to T2MI, including diagnostic criteria, role of advanced cardiac imaging, coding issues, mortality/readmission metrics, health policy, research, among others. fal.cn/AGvR #cvMI