every ICU patient needs an EKG – not a troponin
Demand ischemia is commonly used to describe cardiac ischemia primarily due to cardiac supply/demand mismatch rather than coronary artery disease. In other words, the supply of blood flow to the heart is not limited but is inadequate to match the increased oxygen demands of an increased workload on the heart.
Type-II MI (demand ischemia): Myocardial infarction not involving unstable coronary plaque. This is usually due to stable coronary stenoses in the context of physiologic stress (e.g., anemia, hypoxemia, inotropes, tachycardia). However, Type-II MI can also occur in the setting of normal coronaries due to severe stress (e.g., sustained ...
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.
Demand ischemia is a specific type of ischemia where the oxygen requirements of the myocardium are not being met due to some increased need. In pure demand ischemia, there is no stenosis in the coronary arteries, yet the volume of oxygen-containing blood is insufficient to meet the needs of the heart muscle.
Demand ischemia describes myocardial ischemia primarily due to cardiac supply/demand mismatch rather than CAD. In other words, the supply of blood flow to the heart is not limited but is inadequate to match the increased oxygen demands of an increased workload on the heart.
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.
When you look up the code I24. A1 for a Type 2 MI, the inclusions under the main term include MI due to demand ischemia, and also MI secondary to ischemic imbalance.
Q: How would you code elevated troponin due to demand ischemia? A: I would code I24. 8 (other forms of acute ischemic heart disease). Per the Alphabetic Index, reference Ischemia, demand, I24.
Type 2 MI is defined as "myocardial infarction secondary to ischaemia due to either increased oxygen demand or decreased supply, e.g. coronary artery spasm, coronary embolism, anaemia, arrhythmias, hypertension or hypotension."
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.
Specifically, myocardial injury is defined by at least 1 cardiac troponin concentration above the 99th percentile upper reference limit. Myocardial infarction is a form of myocardial injury but requires clinical evidence of acute myocardial ischemia.
Type 1. Type 1 MI is due to acute coronary atherothrombotic myocardial injury with either plaque rupture or erosion and, often, associated thrombosis. Most patients with ST-segment elevation MI (STEMI) and many with non-ST-segment elevation MI (NSTEMI) fit into this category.
Code I25* is the diagnosis code used for Chronic Ischemic Heart Disease, also known as Coronary artery disease (CAD). It is a is a group of diseases that includes: stable angina, unstable angina, myocardial infarction, and sudden coronary death.
ICD-Code I10 is a billable ICD-10 code used for healthcare diagnosis reimbursement of Essential (Primary) Hypertension.
The three types of heart attacks are: ST segment elevation myocardial infarction (STEMI) non-ST segment elevation myocardial infarction (NSTEMI) coronary spasm, or unstable angina.
Acute nonischemic myocardial injury, a term that applies to patients with dynamic rising and/or falling cTn concentration without clinical evidence of myocardial ischemia, is probably the predominant mechanism for cTn increases in patients with COVID-19.
Indeed, evidence suggests that sepsis may induce perturbations in regional coronary blood flow and microvascular failure leading to myocardial ischemia [12].
STEMI results from complete and prolonged occlusion of an epicardial coronary blood vessel and is defined based on ECG criteria..NSTEMI usually results from severe coronary artery narrowing, transient occlusion, or microembolization of thrombus and/or atheromatous material.
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.
At the most basic level, myocardial injury refers to injury of the muscle cells of the heart. Injured heart muscle cells leak enzymes, namely cardiac troponin. A myocardial injury is defined as cardiac troponins measured at above the 99th percentile of the upper reference limit.
Chronic myocardial injury can be seen with other diagnoses such as chronic ki dney disease and congestive heart failure. Acute myocardial injury can be seen in many situations, including atrial fibrillation, sepsis, and hypovolemia.
However, if the myocard ial injury is due to the presence of a tissue nec rosis factor in the setting of sepsis, then the less specific term of myocardial injury would be more appropriate. In reality, the myocyte injury most likely results from a combination of these factors, and many more.
Myocardial injury can be acute or chronic in nature. In an acute injury, one will see a pattern of rising and falling elevated cardiac troponin levels, as opposed to a chronic injury where the cardiac troponin levels would be elevated but would not demonstrate the rising/falling pattern of an acute injury.