Myocardial injury: Difference between revisions

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==Natural History, Complications, and Prognosis==
==Natural History, Complications, and Prognosis==
*60% of cases of abnormal [[troponin]] concentrations , and 1 in 8 [[patients]] presenting to the [[hospital]] will have evidence of [[myocardial injury]].
*60% of cases of abnormal [[troponin]] concentrations , and 1 in 8 [[patients]] presenting to the [[hospital]] will have evidence of [[myocardial injury]].
* Evidence of [[myocardial injury]] in [[chronic heart failure]] [[disease]] was associated with increased [[all-cause mortality]], [[cardiovascular death]], [[cardiovascular hospitalization]].<ref name="AimoJanuzzi2018">{{cite journal|last1=Aimo|first1=Alberto|last2=Januzzi|first2=James L.|last3=Vergaro|first3=Giuseppe|last4=Ripoli|first4=Andrea|last5=Latini|first5=Roberto|last6=Masson|first6=Serge|last7=Magnoli|first7=Michela|last8=Anand|first8=Inder S.|last9=Cohn|first9=Jay N.|last10=Tavazzi|first10=Luigi|last11=Tognoni|first11=Gianni|last12=Gravning|first12=Jørgen|last13=Ueland|first13=Thor|last14=Nymo|first14=Ståle H.|last15=Brunner-La Rocca|first15=Hans-Peter|last16=Genis|first16=Antoni Bayes|last17=Lupón|first17=Josep|last18=de Boer|first18=Rudolf A.|last19=Yoshihisa|first19=Akiomi|last20=Takeishi|first20=Yasuchika|last21=Egstrup|first21=Michael|last22=Gustafsson|first22=Ida|last23=Gaggin|first23=Hanna K.|last24=Eggers|first24=Kai M.|last25=Huber|first25=Kurt|last26=Tentzeris|first26=Ioannis|last27=Tang|first27=Wai H.W.|last28=Grodin|first28=Justin|last29=Passino|first29=Claudio|last30=Emdin|first30=Michele|title=Prognostic Value of High-Sensitivity Troponin T in Chronic Heart Failure|journal=Circulation|volume=137|issue=3|year=2018|pages=286–297|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.117.031560}}</ref>
* Evidence of [[myocardial injury]] in [[chronic heart failure]] [[disease]] was associated with increased [[all-cause mortality]], [[cardiovascular death]], [[cardiovascular hospitalization]].<ref name="AimoJanuzzi2018">{{cite journal|last1=Aimo|first1=Alberto|last2=Januzzi|first2=James L.|last3=Vergaro|first3=Giuseppe|last4=Ripoli|first4=Andrea|last5=Latini|first5=Roberto|last6=Masson|first6=Serge|last7=Magnoli|first7=Michela|last8=Anand|first8=Inder S.|last9=Cohn|first9=Jay N.|last10=Tavazzi|first10=Luigi|last11=Tognoni|first11=Gianni|last12=Gravning|first12=Jørgen|last13=Ueland|first13=Thor|last14=Nymo|first14=Ståle H.|last15=Brunner-La Rocca|first15=Hans-Peter|last16=Genis|first16=Antoni Bayes|last17=Lupón|first17=Josep|last18=de Boer|first18=Rudolf A.|last19=Yoshihisa|first19=Akiomi|last20=Takeishi|first20=Yasuchika|last21=Egstrup|first21=Michael|last22=Gustafsson|first22=Ida|last23=Gaggin|first23=Hanna K.|last24=Eggers|first24=Kai M.|last25=Huber|first25=Kurt|last26=Tentzeris|first26=Ioannis|last27=Tang|first27=Wai H.W.|last28=Grodin|first28=Justin|last29=Passino|first29=Claudio|last30=Emdin|first30=Michele|title=Prognostic Value of High-Sensitivity Troponin T in Chronic Heart Failure|journal=Circulation|volume=137|issue=3|year=2018|pages=286–297|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.117.031560}}</ref>
*Increases in [[cTnI]] [[concentration]]s in [[patient]]s undergoing high-dose [[chemotherapy]] for [[aggressive]] [[malignant]] [[conditions]] have been correlated with future decreases in [[left ventricular]] [[ejection fraction]].
*Increases in [[cTnI]] [[concentration]]s in [[patient]]s undergoing high-dose [[chemotherapy]] for [[aggressive]] [[malignant]] [[conditions]] have been correlated with future decreases in [[left ventricular]] [[ejection fraction]].
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*Among [[patients]] admitted in [[emergency department]], evidence of acute [[myocardial injury ]] was associated with higher rate of all cause [[mortality]] and [[heart failure]] compared with chronic [[myocardial injury]].<ref name="KadesjoRoos2019">{{cite journal|last1=Kadesjo|first1=Erik|last2=Roos|first2=Andreas|last3=Siddiqui|first3=Anwar J.|last4=Desta|first4=Liyew|last5=Lundback|first5=Magnus|last6=Holzmann|first6=Martin|title=ACUTE VERSUS CHRONIC MYOCARDIAL INJURY AND OUTCOMES|journal=Journal of the American College of Cardiology|volume=73|issue=9|year=2019|pages=105|issn=07351097|doi=10.1016/S0735-1097(19)30713-2}}</ref>
*Among [[patients]] admitted in [[emergency department]], evidence of acute [[myocardial injury ]] was associated with higher rate of all cause [[mortality]] and [[heart failure]] compared with chronic [[myocardial injury]].<ref name="KadesjoRoos2019">{{cite journal|last1=Kadesjo|first1=Erik|last2=Roos|first2=Andreas|last3=Siddiqui|first3=Anwar J.|last4=Desta|first4=Liyew|last5=Lundback|first5=Magnus|last6=Holzmann|first6=Martin|title=ACUTE VERSUS CHRONIC MYOCARDIAL INJURY AND OUTCOMES|journal=Journal of the American College of Cardiology|volume=73|issue=9|year=2019|pages=105|issn=07351097|doi=10.1016/S0735-1097(19)30713-2}}</ref>


*[[Prognosis]] is generally poor especially in non-cardiac causes of [[myocardial injury]] which have higher [[in-hospital]] [[mortality rate]] ( compared with [[cardiac]] causes of chronic [[myocardial injury]]).<ref name="IlvaEskola2010">{{cite journal|last1=Ilva|first1=Tuomo J.|last2=Eskola|first2=Markku J.|last3=Nikus|first3=Kjell C.|last4=Voipio-Pulkki|first4=Liisa-Maria|last5=Lund|first5=Juha|last6=Pulkki|first6=Kari|last7=Mustonen|first7=Harri|last8=Niemelä|first8=Kari O.|last9=Karhunen|first9=Pekka J.|last10=Porela|first10=Pekka|title=The Etiology and Prognostic Significance of Cardiac Troponin I Elevation in Unselected Emergency Department Patients|journal=The Journal of Emergency Medicine|volume=38|issue=1|year=2010|pages=1–5|issn=07364679|doi=10.1016/j.jemermed.2007.09.060}}</ref>
*[[Prognosis]] is generally poor especially in non-[[cardiac]] causes of [[myocardial injury]] which have higher [[in-hospital]] [[mortality rate]] ( compared with [[cardiac]] causes of chronic [[myocardial injury]]).<ref name="IlvaEskola2010">{{cite journal|last1=Ilva|first1=Tuomo J.|last2=Eskola|first2=Markku J.|last3=Nikus|first3=Kjell C.|last4=Voipio-Pulkki|first4=Liisa-Maria|last5=Lund|first5=Juha|last6=Pulkki|first6=Kari|last7=Mustonen|first7=Harri|last8=Niemelä|first8=Kari O.|last9=Karhunen|first9=Pekka J.|last10=Porela|first10=Pekka|title=The Etiology and Prognostic Significance of Cardiac Troponin I Elevation in Unselected Emergency Department Patients|journal=The Journal of Emergency Medicine|volume=38|issue=1|year=2010|pages=1–5|issn=07364679|doi=10.1016/j.jemermed.2007.09.060}}</ref>
* The 5-year [[mortality rate]] of [[patients]] with [[myocardial injury]] is approximately 70%.<ref name="ChapmanShah2018">{{cite journal|last1=Chapman|first1=Andrew R.|last2=Shah|first2=Anoop S.V.|last3=Lee|first3=Kuan Ken|last4=Anand|first4=Atul|last5=Francis|first5=Oliver|last6=Adamson|first6=Philip|last7=McAllister|first7=David A.|last8=Strachan|first8=Fiona E.|last9=Newby|first9=David E.|last10=Mills|first10=Nicholas L.|title=Long-Term Outcomes in Patients With Type 2 Myocardial Infarction and Myocardial Injury|journal=Circulation|volume=137|issue=12|year=2018|pages=1236–1245|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.117.031806}}</ref>
* The 5-year [[mortality rate]] of [[patients]] with [[myocardial injury]] is approximately 70%.<ref name="ChapmanShah2018">{{cite journal|last1=Chapman|first1=Andrew R.|last2=Shah|first2=Anoop S.V.|last3=Lee|first3=Kuan Ken|last4=Anand|first4=Atul|last5=Francis|first5=Oliver|last6=Adamson|first6=Philip|last7=McAllister|first7=David A.|last8=Strachan|first8=Fiona E.|last9=Newby|first9=David E.|last10=Mills|first10=Nicholas L.|title=Long-Term Outcomes in Patients With Type 2 Myocardial Infarction and Myocardial Injury|journal=Circulation|volume=137|issue=12|year=2018|pages=1236–1245|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.117.031806}}</ref>



Revision as of 11:35, 4 August 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Zand, M.D.[2]

Synonyms and keywords:

Overview

myocardial injury is defined as elevated troponin concentrations without sign and symptom indicating overt myocardial ischemia and is the most common causes of increased troponin level. Traditionally, elevated troponin level was eqaul to myocardial infarction. Diagnosis of myocardial injury is a challange for clinicians. By improving the laboratory method for detecting high sensitive troponin and clinical approach to diagnosis the ischemia, patients with myocardial injury due to underlying diseases were excluded and treated. Evaluation and treatment of percipitant factors of myocardial injury including sepsis, anemia, chronic kidney disease, cardiomyopathy are practically indicated. However, patients with evidence of myocardial injury and myocardial ischemia both have poor short and long term outcome.

Historical Perspective

Classification






Classification Definition
Acute myocardial injury Dynamic rise and/or fall of troponin concentration

associated with cardiovascular or noncardiovascular causes

Chronic myocardial injury Stable elevated troponin concentration related to cardiovascular or noncardiovascular causes
Myocardial infarction type 1 Myocardial infarction due to plaque rupture, ulceration, or dissection
Myocardial infarction type 2 Myocardial infarction attributable to oxygen supply-demand

mismatch

Myocardial infarction type 3 Sudden cardiac death associated with myocardial infarction
Myocardial infarction type 4 Myocardial infarction associated with percutaneous intervention or stent thrombosis
Myocardial infarction type 5 Myocardial infarction related to cardiac surgery

Pathophysiology

Causes





Differentiating ((Page name)) from other Diseases

[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].

OR

[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].

Epidemiology and Demographics

The incidence/prevalence of [disease name] is approximately [number range] per 100,000 individuals worldwide.

Risk Factors

Common risk factors in the development of myocardial injury include:

Screening

Natural History, Complications, and Prognosis

Diagnosis

Diagnostic Study of Choice



 
 
 
 
Myocardial injury
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Acute myocardial injury
 
 
 
Chronic myocardial injury
  • Stable but elevated troponin
  •  
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
    History and physical examination
     
     
     
    History and physician examination
  • Laboratory findings
  • Creatinine, glomerular filtration rate
  • Natriuretic peptide
  • Complete blood cell count
  • C-reactive protein, erythrocyte sedimentation rate, D-dimer testing
  • Electrocardiogram
  • Transthoracic echocardiography
  • Cardiac magnetic resonance imaging
  •  
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
    Evidence of myocardial ischemia
     
    NO evidence of ischemia
  • Causes of Nonischemic myocardial injury:
  • Cardiovascular causes:
  • Hypertension
  • Cardiac arrhythmias
  • Acute valvular heart disease
  • Takotsubo cardiomyopathy
  • Cardiac contusions
  • Acute heart failure
  • Pulmonary embolism
  • Myocarditis
  • Aortic dissection
  • Cardiac surgery or procedures
  • Noncardiovascular causes:
  • Acute renal failure
  • Sepsis
  • Anemia
  • Hypotension
  • Hypoxia
  • Noncardiac surgery
  • Critical illness
  • Rhabdomyolysis
  • Drug-induced
  • Stroke, brain hemorrhage
  • Extreme exertion
  •  
    Cardiovascular causes of chronic myocardial injury
  • Chronic heart failure
  • Infiltrative cardiomyopathy
  • Hypertrophic cardiomyopathy
  • Stable coronary artery disease
  • Hypertension
  • Valvular heart disease
  • Persistent arrhythmias
  • Noncardiovascular causes of chronic myocardial injury
  • Chronic renal disease
  • Pulmonary hypertension
  • Diabetes mellitus
  • Drug-induced
  • Toxin exposure
  •  
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
    Management based on the type
     
     
    Management based on the causes of myocardial injury and clinical course
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     

    History and Symptoms

    Common symptoms associated with underlying causes of myocardial injury include:

    Physical Examination

    Laboratory Findings

    Laboratory investigation consistent with the diagnosis of myocardial injury include:


    Electrocardiogram

    There are no specific ECG findings associated with myocardial injury. Findings on an ECG suggestive of myocardial injury may include:

    X-ray

    There are no x-ray findings associated with myocardial injury.

    Echocardiography or Ultrasound

    Echocardiography may be helpful in the diagnosis of underlying causes of myocardial injury.

    CT scan

    There are no CT scan findings associated with myocardial injury. However, a CT scan may be helpful in suspicion of pulmonary thromboembolism or aortic dissection.

    MRI

    Cardiac MRI may be helpful when there is clinically suspicion of myocarditis or infiltrative cardiomyopathy as the underlying causes of myocardial injury.

    Other Imaging Findings

    There are no other imaging findings associated with myocardial injury.

    Other Diagnostic Studies

    There are no other diagnostic studies associated with myocardial injury.

    Treatment

    Medical Therapy


    Surgery

    Surgical intervention is not recommended for the management of myocardial injury.

    Primary Prevention

    There are no established measures for the primary prevention of myocardial injury.

    Secondary Prevention

    There are no established measures for the secondary prevention of myocardial injury.

    References

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    2. Antman, Elliott; Bassand, Jean-Pierre; Klein, Werner; Ohman, Magnus; Lopez Sendon, Jose Luis; Rydén, Lars; Simoons, Maarten; Tendera, Michal (2000). "Myocardial infarction redefined—a consensus document of The Joint European Society of Cardiology/American College of Cardiology committee for the redefinition of myocardial infarction". Journal of the American College of Cardiology. 36 (3): 959–969. doi:10.1016/S0735-1097(00)00804-4. ISSN 0735-1097.
    3. 3.0 3.1 McCarthy, Cian P.; Raber, Inbar; Chapman, Andrew R.; Sandoval, Yader; Apple, Fred S.; Mills, Nicholas L.; Januzzi, James L. (2019). "Myocardial Injury in the Era of High-Sensitivity Cardiac Troponin Assays". JAMA Cardiology. 4 (10): 1034. doi:10.1001/jamacardio.2019.2724. ISSN 2380-6583.
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    9. . doi:10.3969/j.issn.1671-5411.2014.02.011. Missing or empty |title= (help)
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