Contemporary Challenges and Strategies for Diagnosing and Managing in Type 2 Myocardial Infarction: A Narrative Review.

Type 2 myocardial infarction (T2MI) occurs secondary to an imbalance between myocardial oxygen supply and demand, with systemic conditions serving as the primary precipitating factors. T2MI predominantly affects older adults and is frequently accompanied by multiple chronic comorbidities. Therefore, it often has an atypical clinical course and remains a significant diagnostic and therapeutic challenge, particularly given the lack of standardized clinical guidelines. Furthermore, the diagnosis of T2MI in women is especially challenging due to sex-related differences in biomarker kinetics and atypical symptom presentation. The aim of this review is to summarize current knowledge on T2MI, discuss modern diagnostic tools, and analyze sex-related differences in this context in order to identify future directions for the development of therapeutic guidelines. The review emphasizes the need for a multimodal approach, integrating biomarkers, individualized clinical decision-making and advanced cardiac imaging, as differentiation between T2MI and T1MI remains a significant challenge. Therefore, both non-invasive and invasive diagnostic strategies may be required to accurately identify patients with T2MI. Although routine coronary angiography in T2MI is not clearly supported by current evidence, it may be useful as a decisive tool for reclassification, particularly when the clinical presentation is ambiguous.