Copyright
©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Jun 26, 2020; 12(6): 231-247
Published online Jun 26, 2020. doi: 10.4330/wjc.v12.i6.231
Published online Jun 26, 2020. doi: 10.4330/wjc.v12.i6.231
Autonomic neurocardiogenic syndrome is stonewalled by the universal definition of myocardial infarction
Shams Y-Hassan, Coronary Artery Disease Area, Heart and Vascular Theme, Karolinska Institutet and Karolinska University Hospital, Stockholm S-141 86, Sweden
Author contributions: Y-Hassan S designed, edited, and wrote the paper.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Shams Y-Hassan, MBChB, MD, Doctor, Research Scientist, Cardiologist senior consultant, Coronary Artery Disease Area, Heart and Vascular Theme, Karolinska Institutet and Karolinska University Hospital, SE‐171 76, Stockholm S-141 86, Stockholm, Sweden. shams.younis-hassan@sll.se
Received: October 30, 2019
Peer-review started: October 30, 2019
First decision: December 12, 2019
Revised: April 27, 2020
Accepted: May 14, 2020
Article in press: May 14, 2020
Published online: June 26, 2020
Peer-review started: October 30, 2019
First decision: December 12, 2019
Revised: April 27, 2020
Accepted: May 14, 2020
Article in press: May 14, 2020
Published online: June 26, 2020
Core Tip
Core tip: The fourth universal definition of myocardial infarction (MI) needs reconsideration. Type 2 MI and MI with non-obstructive coronary arteries are not evidence-based. Autonomic neuro-cardiogenic (ANCA) syndrome is the second important cause of troponin elevation after acute coronary ischemia. Troponin release in ANCA syndrome is most probably due to cardiac cramp squeezing the cardiomyocyte causing mild to moderate release of troponin from the cytosolic free pool. ANCA syndrome may occur in an acute form as in takotsubo syndrome. The syndrome may also occur in recurrent or a chronic form as in chronic heart failure with acute exacerbations, and chronic kidney diseases.