Treatment of Type II MI’s

By  |  June 18, 2018 | 

Fill in the Blanks:

Q: “The diagnosis of type 2 MI is associated with a _____ prognosis.  ___% of patients will live five years after their diagnosis.”

The answer is a) POOR and b) a staggering 40%. I did not know that. However, what I am aware of is the ambiguity around Type 2 MIs and what their presence in a patient presentation implies. For years, I have caught fellows and colleagues stating, “oh, its demand ischemia.” Not once, have I heard that and accepted the description as satisfying. Not a single time.

I ask specialists, “Okay, then what—what’s next and does saying demand ischemia translate to no monitoring, no new meds, and carry on with what you planned on doing because it is not Type 1.” I get shrugs.

No definition has befuddled and confused more than the one below:

“Mismatch between myocardial oxygen supply and demand driven by a secondary process other than coronary artery disease.”

 A commentary in JAMA, and it’s short and a 5-10 minute read tops, puts into words EXACTLY what I have felt for the last decade since the moniker came into vogue. They extol in clear terms, we have little data and do not know what the hell we are doing when we manage this problem.

What we have gleaned, however, is a Type 2 MI accompanying any multi-morbid presentation portends a lousy prognosis–even worse than a Type I. Again, we don’t know next steps in management and what drugs to start, if any.  Grande problemo.

Channeling Voltaire, and perhaps more apropos to the condition, we might better characterize Type 2 as such: “The art of medicine consists of amusing the patient while nature cures the disease.”

If your group runs a journal club, this would make a killer topic. Go to it.

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About the Author: Brad Flansbaum

Brad Flansbaum
Bradley Flansbaum, DO, MPH, MHM works for Geisinger Health System in Danville, PA in both the divisions of hospital medicine and population health. He began working as a hospitalist in 1996, at the inception of the hospital medicine movement. He is a founding member of the Society of Hospital Medicine and served as a board member and officer. He speaks nationally in promoting hospital medicine and has presented at many statewide meetings and conferences. He is also actively involved in house staff education. Currently, he serves on the SHM Public Policy Committee and has an interest in payment policy, healthcare market competition, health disparities, cost-effectiveness analysis, and pain and palliative care. He is SHM’s delegate for the AMA House of Delegates. Dr. Flansbaum received his undergraduate degree from Union College in Schenectady, NY and attended medical school at the New York College of Osteopathic Medicine. He completed his residency and chief residency in Internal Medicine at Long Island Jewish Medical Center in New York. He received his M.P.H. in Health Policy and Management at Columbia University. He is a political junky, and loves to cook, stay fit, read non-fiction, listen to many genres of music, and is a resident of Danville, PA.

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