This handout is for type-2 mi (demand ischemia, no plaque rupture). Your care team identified this based on: hstn rise/fall in patient with sepsis, severe anemia, tachyarrhythmia, hypoxia, hypotension, severe htn, or drug toxicity (4th udmi 2018).
Other reasons your team may use this plan: hstn elevation without ischemic ecg and without clinical acs syndrome — supports type-2 vs type-1; sepsis or septic shock with hstn rise — most common type-2 trigger; treat sepsis bundle first per ssc 2026; af with rvr / svt / sinus tachycardia >150 with hstn rise — rate control first.
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| aspirin | 81 mg daily | PO | daily IF known obstructive CAD; otherwise NO antiplatelet for type-2 MI alone | ACC/AHA 2025 — treat trigger primarily; antiplatelet only if obstructive CAD known. Type-2 MI 1-yr mortality 37% vs type-1 28% but driven by comorbidity not by deferred antithrombotic per DeFilippis PMID 30689349 |
| atorvastatin | 40-80 mg daily | PO | daily IF known obstructive CAD or independent ASCVD indication | PROVE-IT PMID 15007110 — benefit established in type-1 ACS; type-2 use depends on CAD status not on type-2 event itself per ACC/AHA 2025 |
| metoprolol_tartrate | 5 mg IV q5 min × 3 if AF with RVR + stable; OR PO 25 mg BID | IV/PO | titrate to HR <110 | Rate control for tachyarrhythmia trigger; AVOID in cocaine-induced (unopposed alpha) per AHA 2008 cocaine chest pain pathway |
| diltiazem | 0.25 mg/kg IV bolus → 5-15 mg/h infusion | IV | continuous titrate to HR <110 | Rate control alternative when β-blocker contraindicated; 2024 AHA AF guideline |
| norepinephrine | 0.05-0.5 µg/kg/min titrate MAP ≥65 | IV | continuous | SOAP-II first-line vasopressor; restoring perfusion corrects demand-supply mismatch driving type-2 MI |
Plan: Type-2 MI trigger-targeted therapy — antithrombotic only if known obstructive CAD per ACC/AHA 2025; treat the trigger primarily per 4th UDMI 2018 PMID 30153967
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Outpatient cardiology + stress test or CCTA if recovers — to detect underlying obstructive CAD that contributed to demand-supply ischemia. Optimise comorbidities (sepsis recovery, HF, CKD, DM)
Guideline: 4th Universal Definition of MI 2018 (Thygesen Circulation 2018, PMID 30153967); 2025 ACC/AHA ACS Guideline (Rao); ESC 2023 NSTE-ACS Guideline (Byrne, PMID 37622670)