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  • Ischemic imbalance: Spontaneous clinical syndrome where a condition other than coronary artery disease contributes to an imbalance between myocardial oxygen supply and/or demand, e.g. coronary endothelial dysfunction, coronary artery spasm, coronary embolism, tachy-/brady-arrhythmias, anemia, respiratory failure, hypotension, and hypertension with or without left ventricular hypertrophy. This classification requires detection of a rise and/or fall of cardiac biomarker values [preferably cardiac troponin (cTn)] with at least one value greater than 99th percentile of the upper reference limit (URL) and b) at least one of the following: symptoms of myocardial ischemia; new or presumed new significant ST-segment-T wave (ST-T) changes or new left bundle branch block (LBBB) on the ECG; development of pathological Q waves on the ECG; imaging evidence of new loss of viable myocardium or new regional wall motion abnormality. (Universal definition of myocardial infarction, Kristian Thygesen, Joseph S. Alpert and Harvey D. White on behalf of the Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction, Eur Heart J (2007) 28 (20): 2525-2538.)
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