Type 2 MI (T2MI) was defined as myocardial infarction other than due to coronary artery disease (CAD), produced by disparity between supply and demand of oxygen .Cases were reported in literature where T2 MI was diagnosed even in presence of 90% block in coronaries, where recent ischemic changes were shown to be not due to the CAD, but to disparity between supply and demand of oxygen. There was considerable overlap with the classical type 1 NSTE MI and T2 MI. Distinguishing between the two was considered challenging. Though T2 MI constituted about 25% of all cases of MI, the centres reporting Type 2 MI ranged between 0-13% only. Type 2 MI, the new heterogeneous group, was officially recognised by the task force on the universal definition of MI in 2007. The scope and criteria were changing since it was defined in 2007. Further, it appeared that -coronary cause of MI was more important than disparity between supply and demand of myocardial oxygen supply. For instance Sepsis, one of the important causes of T2 MI, could cause Type 2 MI by myocardial depression even in presence of normal oxygen perfusion.

A case diagnosed initially as NSTEMI, was retrospectively considered the possibility of T2MI. The reasons there of and the intricacies in the diagnosis of T2 MI are discussed in this article.

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