Anterior myocardial infarction is a term denoting ischemia and necrosis of the anterior myocardial wall due to occlusion of the left anterior descending artery. A sudden onset of chest pain that often radiates to the arm and neck accompanied by dyspnea, nausea, vomiting, weakness, and diaphoresis are some of the most common symptoms. Laboratory workup, electrocardiography (the V1-V4 precordial leads are specific for the anterior wall), and sometimes coronary angiography are essential steps to confirm myocardial infarction, but clinical suspicion is critical for an early diagnosis.
Despite the fact that myocardial infarction possesses a different pathogenesis in terms of its location and vessel involved, the clinical presentation is similar. In the case of anterior myocardial infarction, signs and symptoms stem from occlusion of the left anterior descending artery, the blood vessel responsible for supplying this part of the heart . Across many studies, chest pain is identified as the most frequent finding, typically described as a burning or squeezing sensation . It is seen in > 90% of patients   . Pain may be mild or quite severe and is further described as retrosternal, precordial, or radiating to various anatomical sites, such as the jaw, the neck, the shoulder, and arms, as well as posteriorly toward the interscapular region of the back   . Radiation of pain is usually unilateral but individuals in whom bilateral spread occurred are also reported  [3 . In the vast majority of cases, chest pain persists for more than 20 minutes . In addition to pain, other common complaints include nausea, vomiting, dyspnea, shortness of breath, diaphoresis, abdominal pain, fatigue, dizziness, and palpitations   . Interestingly, some studies highlight that multiple features are more commonly encountered among women compared to men, without an obvious explanation .
Entire Body System
- Coronary Atherosclerosis
According to a study by Garg and his colleagues, incidence of coronary atherosclerosis in patients with CAA was found to be %10.25 . On the other hand, most of the literatures do not demonstrate a strong relation between CAA and atherosclerosis. [hindawi.com]
Associations of coronary heart disease risk factors with the intermediate lesion of atherosclerosis in youth. The Pathobiological Determinants of Atherosclerosis in Youth (PDAY) Research Group. [emedicine.medscape.com]
- Chest Pain
A 50-year-old male with known dextrocardia and situs inversus presented with acute chest pain radiating to the right arm. [ncbi.nlm.nih.gov]
Radiation of pain is usually unilateral but individuals in whom bilateral spread occurred are also reported [3. In the vast majority of cases, chest pain persists for more than 20 minutes. [symptoma.com]
Chest pain with these ECG changes is a clear indication to an acute coronary angiography. In subacute forms of a STEMI, the ST elevations are accompanied by gradual formation of deep Q waves that mark myocardial necrosis. [health-tutor.com]
- Heart Disease
Because the patient had no significant risk factors for coronary heart disease, the infarction was likely caused by the chemotherapy regimen. [ncbi.nlm.nih.gov]
ischemic heart disease, valvular heart disease, e) patients who died in the early phase of acute anterior myocardial infarction before echocardiographic examination, and f) patients with relative or absolute contraindication to thrombolytic therapy. [medical-dictionary.thefreedictionary.com]
There is heart disease in my family. Does “possible anterior infarct, age undetermined” mean I may have had a heart attack? Should I be overly concerned? What else could cause this abnormality? Thank you. [texasheart.org]
Ischemic heart diseases Use Additional code to identify presence of hypertension ( I10-I16 ) Ischemic heart diseases I21 ICD-10-CM Diagnosis Code I21 Acute myocardial infarction 2016 2017 2018 - Revised Code 2019 Non-Billable/Non-Specific Code Includes [icd10data.com]
The diagnosis of a myocardial infarction must be made as soon as possible. For this reason, the physician must promptly obtain a detailed history and assess the signs that are present. To confirm the exact location of the infarction and its severity, it is necessary to perform specific laboratory studies that focus on "cardiac markers" and electrocardiography     . Troponins T and I, very specific markers of myocardial injury, become elevated within several hours after myocardial infarction and their highest values are estimated to be around 24 hours after the initial event . Creatine kinase myocardial band (CK-MB), initially used an equally important biomarker of cardiac injury , is now regarded as an unnecessary test due to its little value and accuracy . For this reason, troponin remains the key biochemical exam    . Electrocardiography is, perhaps, the crucial component of the workup in people in whom myocardial infarction is suspected. The diagnosis is made when the elevation of the ST segment at the J-point, ST depression, or inversion of the T wave is seen in 2 contiguous leads (with slightly different cutoff values for men and women)   . Anterior myocardial infarction is confirmed when these findings are shown on the precordial leads V1-V4 . In some patients, coronary angiography or other imaging studies of the heart can be used to further elucidate the severity of infarction .
- Poor R Wave Progression
The remarkable feature is the poor R wave progression in the V1 and V2 leads and the ST elevation and T wave changes in leads V1 to V4 and I and aVL. The cardiogram suggests an anterior/ lateral MI possibly acute. [wikidoc.org]
If there is an R wave in V1 or V2, the term poor R wave progression, but not old anterior wall MI, can be used. [healio.com]
waves in V1 or V2 may mimic true posterior MI) Complete or incomplete LBBB (QS waves or poor R wave progression in leads V1-3) Pneumothorax (loss of right precordial R waves) Pulmonary emphysema and cor pulmonale (loss of R waves V1-3 and/or inferior [ecg.utah.edu]
QT, RR, ST Intervals
- ST Elevation
ECG was recorded in acute phase ( RESULTS: Anterior-STEMI patients had ST-elevation in lead V1 more frequently than apical (70% vs 15%, p CONCLUSIONS: In patients with anterior ST-elevation and acute chest pain, lack of ST-elevation in lead V1 and ST-elevation [ncbi.nlm.nih.gov]
An anterior MI is characterized by the presence of ST elevation in the anterior leads V3 and V4. ST elevation in V1 and V2 corresponds to septal infraction whereas ST elevation in leads V5 and V6 corresponds to apical infarction. [wikidoc.org]
Thus, investigators from the GUSTO-I angiographic and the GUSTO-IIb angioplasty substudies evaluated the 1046 patients with anterior ST elevation and divided them into 3 groups: 1) those with inferior ST elevation also (n = 179); 2) those with no inferior [ahcmedia.com]
ST elevation (STEMI) myocardial infarction involving other coronary artery of anterior wall I21.1 ST elevation (STEMI) myocardial infarction of inferior wall I21.11 ST elevation (STEMI) myocardial infarction involving right coronary artery I21.19 ST [icd10data.com]
- ST Elevation in Anterior Leads
For example, ST elevation in anterior leads should produce depression in inferior leads, and elevation in lateral leads should produce depression in septal leads. However, do not rely on reciprocal changes to diagnose STEMI. [emdocs.net]
- T Wave Inversion
Evolved anterior wall myocardial infarction ECG shows sinus rhythm at a rate of around 100/min, with QS complexes in anterior leads along with a coved ST segment elevation and T wave inversion, suggesting evolved anterior wall myocardial infarction (AWMI [cardiophile.org]
[…] degrees Tall R Wave rotates to a Q waves ST depression rotates to ST Elevation T Wave rotates to T Wave inversion Distribution Distal Right Coronary Artery : Posterior descending Left Coronary Artery : Circumflex Complications Left Ventricular Dysfunction [fpnotebook.com]
Normal ECG prior to MI Hyperacute T wave changes - increased T wave amplitude and width; may also see ST elevation Marked ST elevation with hyperacute T wave changes (transmural injury) Pathologic Q waves, less ST elevation, terminal T wave inversion [ecg.utah.edu]
There is also a loss of general R wave progression across the precordial leads and there may be symmetric T wave inversion as well. [meds.queensu.ca]
Other ECG Findings
- Electrocardiogram Change
[…] ischaemia NOS (finding), Electrocardiogram finding of ischemia (finding), Electrocardiogram finding of ischemia, ECG: myocardial ischaemia (finding), Electrocardiogram: myocardial ischaemia NOS, Electrocardiogram: myocardial ischemia NOS, Electrocardiogram [fpnotebook.com]
There is no guiding suggestion for the treatment of SCAD. The main treatment methods are 3 aspects: conservative internal medical treatment, stent implantation, coronary artery bypass grafting. [ncbi.nlm.nih.gov]
Thrombolytic treatment was not given because of the time which had elapsed from symptom onset. [heart.bmj.com]
or a bone-marrow-stem-cell group (n=16) that received optimum treatment plus intracoronary infusion of autologous bone-marrow stem cells 4±1 days after PCI. [bloodjournal.org]
Anterior myocardial infarction carries the worst prognosis of all infarct locations, mostly due to larger infarct size. [lifeinthefastlane.com]
Prognosis of angina pectoris and coronary occlusion. Follow-up of 1,700 cases.J.A.M.A. 1951; 146: 998 Sigler L.H. Prognosis of angina pectoris and myocardial infarction, further report.Am. J. [ajconline.org]
Abstract A study was carried out in metropolitan Baltimore in which the short- and long-term prognosis of 655 patients with anterior myocardial infarction (MI) was compared with that of 520 patients with inferior/posterior MI. [ncbi.nlm.nih.gov]
Prognosis correlates with the degree of myocardial necrosis. Greater degrees of myocardial necrosis are associated with a worse prognosis. [patient.info]
Thus, we believe that increased atherosclerosis plus thrombotic process is the main etiology in our patient. [karger.com]
But there are other suspicious etiologic reasons that lead to coronary embolism, such as intracardiac prosthesis, infective endocarditis, mural thrombus or a cardiac tumor [1-8]. [austinpublishinggroup.com]
To read this article in full you will need to make a payment References Barlow JB Bosman CK Pocock WA Marchand P Late systolic murmurs and nonejection systolic clicks: an analysis of 90 patients.Br Heart J. 1968; 30: 203 Pocock WA Barlow JB Etiology and [amjmed.com]
But there are other suspicious etiologic reasons that lead to coronary embolism such as intracardiac prosthesis, infective endocarditis, mural thrombus or a cardiac tumor [ 1 - 7 ]. [omicsonline.org]
All patients were epidemiologically and clinically similar. There were 6 bleeding episodes that required blood transfusion and 11 episodes of minor bleeding. [ncbi.nlm.nih.gov]
A comparison was made with the epidemiological characteristics, treatment, and 30 day-outcome of patients with (Group 1) and without (Group 2) heart failure after infarction. [elsevier.es]
EPIDEMIOLOGY OF MYOCARDIAL INFARCTION Estimates are that approximately 1.2 million people in the United Stated experience a fatal or non-fatal acute MI each year. Approximately every minute, an American dies of an acute myocardial infarction. [calshipleymd.com]
EPIDEMIOLOGY Myocardial infarction is a common presentation of ischemic heart disease, the leading cause of death in developed countries, and third to AIDS and lower respiratory infections in developing countries. [sites.google.com]
Early recognition of the underlying pathophysiological mechanism might have major therapeutic implications and could decrease the risk of myocardial rupture. [ncbi.nlm.nih.gov]
Abstract To elucidate the pathophysiological role of diabetes mellitus in determining the left ventricular regional function of the noninfarcted area, 55 patients with acute Q wave anterior myocardial infarction (MI) were studied. [care.diabetesjournals.org]
PROCEED TO STEMI DIAGNOSIS Related links: Introduction Pathophysiology Physical Examination Diagnosis Treatment - Revascularization Treatment - Medical Special Situations Review Questions - STEMI - Multiple Choice Review Questions - STEMI - Case Based [healio.com]
CONCLUSIONS: The available studies of LVT/SE prevention after MI lacked statistical power and are heterogeneous in terms of treatments, revascularization methods, background medical therapy, and study design. [ncbi.nlm.nih.gov]
No prospective randomized controlled trial using warfarin has been conducted to study its efficacy after anterior STEMI in preventing left ventricular thrombus for prevention of stroke. [journals.plos.org]
Pain relief and prevention of complications are also important in management. [healthguideinfo.com]
- Morris F, Brady WJ. Acute myocardial infarction—Part I. BMJ. 2002;324(7341):831-834.
- Malik MA, Alam Khan S, Safdar S, Taseer I-U-H. Chest Pain as a presenting complaint in patients with acute myocardial infarction (AMI). Pakistan Journal of Medical Sciences. 2013;29(2):565-568.
- Lu L, Liu M, Sun R, Zheng Y, Zhang P. Myocardial Infarction: Symptoms and Treatments. Cell Biochem Biophys. 2015;72(3):865-867.
- Berg J, Björck L, Dudas K, Lappas G, Rosengren A. Symptoms of a first acute myocardial infarction in women and men. Gend Med. 2009;6(3):454-462 .
- Fleischmann KE, Zègre-Hemsey J, Drew BJ. The New Universal Definition of Myocardial Infarction Criteria Improves Electrocardiographic Diagnosis of Acute Coronary Syndrome. J Electrocardiol. 2011;44(1):69-73.
- Stillman AE, Oudkerk M, Bluemke D, et al. Assessment of acute myocardial infarction: current status and recommendations from the North American society for cardiovascular imaging and the European society of cardiac radiology. Int J Cardiovasc Imaging. 2011;27(1):7-24.
- McCann CJ, Glover BM, Menown IB, et al. Novel biomarkers in early diagnosis of acute myocardial infarction compared with cardiac troponin T. Eur Heart J. 2008;29:2843–2850.
- Jaffe AS, Babuin L, Apple FS. Biomarkers in acute cardiac disease: the present and the future. J Am Coll Cardiol. 2006;48:1–11.
- Morrow DA, Cannon CP, Rifai N, et al. Ability of minor elevations of troponins I and T to predict benefit from an early invasive strategy in patients with unstable angina and non-ST elevation myocardial infarction: results from a randomized trial. JAMA. 2001;286:2405–2412.
- Alvin MD, Jaffe AS, Ziegelstein RC, Trost JC. Eliminating Creatine Kinase-Myocardial Band Testing in Suspected Acute Coronary Syndrome: A Value-Based Quality Improvement. JAMA Intern Med. 2017 Aug 14.
- Thygesen K, Alpert JS, White HD; Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction. Universal definition of myocardial infarction. J Am Coll Cardiol. 2007;50 (22):2173–2195.
- Ben-Gal T, Herz I, Solodky A, Birnbaum Y, Sclarovsky S, Sagie A. Acute anterior wall myocardial infarction entailing ST-segment elevation in lead V1: electrocardiographic and angiographic correlations. Clin Cardiol.1998;21(6):399-404.