Myocardial Infarction

Question 1

Type I (Spontaneous MI)

Answer 1

related to atherosclerotic plaque rupture, ulceration, fissuring, erosion or dissection w/ resulting intraluminal thrombus in one or more of the coronary arteries –> decreased myocardial blood flow or distal platelet emboli –> myocardial necrosis

Question 2

Type II (MI secondary to Ischemic Imbalance)

Answer 2

condition other than CAD contributes to an imbalance b/w myocardial oxygen supply and/or demand (coronary endothelial dysfunction, coronary artery spasm, coronary embolism, tachy/bradyarrhythmias, anemia, respiratory failure, hypotension and hypertension w/ or w/o LV hypertrophy)

Question 3

Type III (MI resulting in Death when Biomarkers are Unavailable)

Answer 3

cardiac death w/ symptoms suggestive of ischemia and presumed new ischemic changes (or new LBBB) but death occurring before blood samples could be obtained

Question 4

Type 4a (MI related to PCI)

Answer 4

percentile of the URL in patients with normal baseline values (<99^th percentile URL)

OR

rise of values over 20% if the baseline values are elevated but stable or falling

any of the following are required:

1. symptoms suggestive of myocardial ischemia
2. new ischemic ECG changes or new BBB
3. angiographic loss of patency of a major coronary artery or a side branch or persistent slow flow or no flow or embolization
4. demonstration of the new loss of viable myocardium or new regional wall motion abnormality by cardiac imaging

Question 5

Type 4b (MI related to stent thrombosis)

Answer 5

detected by coronary angiography or autopsy in the setting of myocardial ischemia in combination with a rise and/or fall of cardiac biomarkers with at least one value above the 99 th percentile URL

Question 6

Type 5 (MI related to CABG)

Answer 6

elevation of cardiac biomarker values more than 10 times the 99 th percentile URL in patients with normal baseline cTn values

in addition either:

1. new pathologic Q waves or new BBB
2. angiographic-documented new graft or native coronary artery occlusion
3. evidence of new loss of viable myocardium or new regional wall motion abnormality by cardiac imaging is required