Autonomic neurocardiogenic syndrome is stonewalled by the universal definition of myocardial infarction

Table 1 Diagnostic criteria for type 1, type 2, and type 3 myocardial infarction according to the fourth universal definition of myocardial infarction

Criteria for type 1 MI, type 2 MI, type 3 MI according to the fourth universal definition of myocardial infarction[1]
Type 1 MI
Detection of a rise and/or fall of cTn values with at least one value above the 99th percentile URL and with at least one of the following:
Symptoms of acute myocardial ischaemia
New ischaemic ECG changes
Development of pathological Q waves
Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality in a pattern consistent with an ischemic etiology
Identification of a coronary thrombus by angiography including intracoronary imaging or by autopsy
Type 2 MI
Detection of a rise and/or fall of cTn values with at least one value above the 99th percentile URL, and evidence of an imbalance between myocardial oxygen supply and demand unrelated to coronary thrombosis, requiring at least one of the following:
Symptoms of acute myocardial ischaemia
New ischaemic ECG changes
Development of pathological Q waves
Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality in a pattern consistent with an ischaemic aetiology
Type 3 MI
Patients who suffer cardiac death, with symptoms suggestive of myocardial ischaemia accompanied by presumed new ischemic ECG changes or ventricular fibrillation but die before blood samples for biomarkers can be obtained, or before increases in cardiac biomarkers can be identified, or MI is detected by autopsy examination

MI: Myocardial infarction; ECG: Electrocardiogram; cTn: Cardiac troponin; URL: Upper reference limit.