The 2018 Consensus Paper "Universal Definition of Myocardial Infarction" published by the European and American Society of Cardiology (ESC/ACC) made a detailed distinction between myocardial injury and myocardial infarction. Increased troponin levels alone are required for the diagnosis of "myocardial injury". In the presence of clinical signs of ischemia in addition to the myocardial damage measured by serum troponin, it results in the diagnosis of myocardial infarction. Myocardial injury can be caused by a variety of cardiac and extracardiac disorders and even exceeds myocardial infarction in mortality. Due to the heterogeneity of the patients, "myocardial injury" is a particular challenge in everyday clinical practice.