Demand ischemia, reported with ICD-10-CM code I24. 8 (other forms of acute ischemic heart disease), refers to the mismatch between myocardial oxygen supply and demand, which is evidenced by the release of cardiac troponin.
According to official coding guidelines, a "NSTEMI probably due to demand ischemia" is assigned to code I21. A1, Myocardial infarction type 2 with the underlying cause coded first.
Demand ischemia is an inexact term that is frequently used incorrectly. Demand ischemia is a physiologic description that should be used when the demand for myocardial oxygen is greater than the supply (supply-demand mismatch).
Demand ischemia should be reserved for when there is evidence of supply-demand mismatch causing ischemia without an elevated troponin above the 99th percentile. If the troponin is > 99th percentile the diagnosis is a Type 2 MI.
For example, a physician recently documented that a patient had elevated troponin, likely a Type 2 MI/demand ischemia in the setting of a hypertensive emergency. In this case, demand ischemia would be a CC, and Type 2 MI would affect the DRG assignment, but it wouldn't add a CC/MCC.
The elevated troponins in the bloodstream indicate that there has been damage to the heart muscle and therefore can be an indicator of demand ischemia or a heart attack.
(NSTEMI) is a common diagnosis in hospitalized patients. Type 2 has been reported up to 25% of cases of MI depending on the population studied. Type 2 NSTEMI is defined as myocardial ischemia resulting from mismatched myocardial oxygen supply and demand that is not related to unstable coronary artery disease (CAD).
Myocardial ischemia can lead to serious complications, including: Heart attack. If a coronary artery becomes completely blocked, the lack of blood and oxygen can lead to a heart attack that destroys part of the heart muscle. The damage can be serious and sometimes fatal.
The goal of myocardial ischemia treatment is to improve blood flow to the heart muscle....Medications to treat myocardial ischemia include:Aspirin. ... Nitrates. ... Beta blockers. ... Calcium channel blockers. ... Cholesterol-lowering medications. ... Angiotensin-converting enzyme (ACE) inhibitors. ... Ranolazine (Ranexa).
2 for Subsequent non-ST elevation (NSTEMI) myocardial infarction is a medical classification as listed by WHO under the range - Diseases of the circulatory system .
Type 1 MI is a primary coronary arterial event attributable to atherothrombotic plaque rupture or erosion. Type 2 MI occurs secondary to an acute imbalance in myocardial oxygen supply and demand without atherothrombosis.
Types 1 and 2 MI are spontaneous events, while type 4 and type 5 are procedure-related; type 3 MI is identified only after death. Most type 1 and type 2 MI present as non-ST-elevation MI (NSTEMI), although both types can also present as ST-elevation MI.