Type II MI vs NSTEMI

[mossyfiber12]

I am getting confused. As far as I understood, NSTEMI can be due to obstructive CAD in the setting of supply demand mismatch. This is the same thing as type II MI, right?

I am kind of confused how to classify the Type I and II MI into the STEMI/NSTEMI/UA and demand ischemia pathophysiology.

If you guys can clear this up for me then that would be great.

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[Trifling Jester]

We never really used the whole type I type II terminology where I trained. If they guy was coming in with chest pain we called it an NSTEMI and took him to the lab. If he was one of those septic types tach'ing away with a troponin bump we just signed off and told them to have him follow up in clinic if/when he recovered. But then we weren't one of those fancy ivory tower fellowships either

 

[mrpankration]

Bear in mind I'm not a Cardiologist or even a Cardiology fellow, so I probably don't have the most educated answer, but, my understanding is,
Type 1 MI: primary plaque rupture and subsequent thrombosis causing infarction (usually amenable to revascularization).
Type 2 MI: primarily a supply-demand mismatch issue i.e. rate-related ischemia, sepsis, anemia, acute HF, hypertensive emergency (not usually amenable to revascularization treat the underlying insult).

The term NSTEMI is kind of non-specific, because you can have an NSTEMI (myocardial injury) with either mechanism. It doesn't necessarily mean they're treated the same way.

 

[nlax30]

Unfortunately a lot of how we document is meant to appease the coders and we use something like "elevated troponin like a type 2 event/injury" if we want to document what we're saying is a type 2 MI due to imbalance and some other co-morbidity and not obstructive/unstable coronary plaque or rupture that would trigger the coders and clipboard nurses for MI core measures.

If a true MI then we'll say ACS/NSTEMI OR unstable angina or acute MI or whichever fits.

Somewhat similar with CHF where the current lingo doesn't match up with billing language. For notes I I'd use acute in chronic systolic heart failure with decompensation but talking with a colleague I may use HFrEF.

 

[nlax30]

Here's a decent little editorial talking about the discrepancy between clinically language/definitions and coding language.

http://www.hcpro.com/hom-235659-5728/demand-a-code-for-demand-myocardial-infarction.html