Pseudo myocardial infarction - a condition in need to be redefined?

Area of Science:

• Cardiology
• Biochemistry

Background:

• Elevated cardiac troponin levels in patients with chest pain often indicate myocardial infarction.
• However, a subset of patients presents with elevated troponin without significant coronary artery disease (CAD).
• Potential causes include pulmonary embolism, myocarditis, sepsis, trauma, arrhythmias, and cardiomyopathies.

Purpose of the Study:

• To propose the classification of chest pain with elevated troponin, in the absence of definite myocardial infarction or CAD, as pseudo myocardial infarction (PMI).
• To advocate for PMI as a working diagnosis to guide clinical decision-making and prevent unnecessary interventions.
• To highlight the importance of recognizing PMI as a potentially serious condition, not a benign finding.

Main Methods:

• Review of existing literature and clinical observations regarding patients with elevated troponin and chest pain without obstructive CAD.
• Conceptualization and definition of pseudo myocardial infarction (PMI) as a syndrome.
• Discussion of potential underlying mechanisms, including myocardial strain.

Main Results:

• A significant number of patients exhibit elevated troponin levels with chest pain but lack significant coronary artery disease.
• Myocardial strain, possibly due to stretch-responsive integrin stimulation, is a proposed mechanism for troponin release.
• Pseudo myocardial infarction (PMI) is proposed as a unifying concept for this clinical presentation.

Conclusions:

• Pseudo myocardial infarction (PMI) is a syndrome characterized by chest pain and elevated cardiac troponin in the absence of myocardial infarction or significant CAD.
• PMI serves as a crucial working diagnosis, facilitating the avoidance of unnecessary cardiac investigations, drug therapies, and legal liabilities.
• Despite its heterogeneous nature, PMI must not be underestimated, as it represents a group of conditions that can lead to serious outcomes.