A Narrative Review of the Management of Type 2 Myocardial Infarction and Myocardial Injury in Medical Patients in the UK

TL;DR

This paper reviews how Type 2 myocardial infarction is managed in UK medical patients, highlighting challenges and the need for national guidance.

Contribution

The paper provides a synthesis of current evidence and guidelines for T2MI management in the UK, identifying gaps and areas needing further research.

Findings

T2MI is associated with increased mortality in medical patients.

Current UK management lacks national guidance, leading to variability in care.

Diagnostic and management challenges include overlapping symptoms with non-ischaemic injury.

Abstract

Type 2 myocardial infarction (T2MI) is defined as myocardial injury occurring due to an imbalance between myocardial oxygen supply and demand rather than acute atherothrombotic plaque rupture. It is frequently encountered in acutely unwell medical patients and is associated with adverse short- and long-term outcomes, including increased inpatient, 30-day, and one-year mortality. Diagnosis and management remain challenging due to heterogeneous clinical presentations, frequent coexistence with systemic illness, and overlap with acute non-ischaemic myocardial injury. In the UK, there is currently no national guidance specific to T2MI, resulting in variability in diagnostic approaches and management strategies, with clinicians often extrapolating from acute coronary syndrome pathways and international consensus statements. This narrative review synthesises contemporary evidence from observational studies, guideline documents, and expert consensus to discuss the pathophysiology, diagnosis, investigation, and management of T2MI in medical inpatients, highlighting key uncertainties and areas requiring future research.