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
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]
Role of endothelial shear stress in the natural history of coronary atherosclerosis and vascular remodeling: molecular, cellular, and vascular behavior. J Am Coll Cardiol. 2007 Jun 26. 49(25):2379-93. [Medline]. [emedicine.medscape.com]
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]
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. [symptoma.com]
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]
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]
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 cardiac infarction [icd10data.com]
Myocardial Infarction: A Companion to Braunwald’s Heart Disease, by David A. Morrow, MD, is a comprehensive, hands-on resource that provides practical guidance from a name you trust. [books.google.com]
Case report A 68-year-old man with hypertension, dyslipidemia and ischemic heart disease, with a previous infarction in 2001 when he underwent percutaneous angioplasty of the anterior descending coronary artery, presented at our emergency room with shock [elsevier.pt]
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 .
Right Axis Deviation
Right-axis deviation was present in 4.3% of patients with RBBB at randomization and 6% of patients with new RBBB at 60 minutes. [circ.ahajournals.org]
axis deviation) Left anterior fascicular block (may see small q-waves in anterior chest leads) Acute pericarditis (the ST segment elevation may mimic acute transmural injury) Central nervous system disease (may mimic non-Q wave MI by causing diffuse [ecg.utah.edu]
Poor R Wave Progression
Copyleft image obtained courtesy of, Shown below is an EKG showing ST elevation in the anterior precordial leads, low voltages in all the leads, poor R wave progression in the precordial leads. [wikidoc.org]
This is sometimes termed "poor R wave progression" or PRWP. Note: To distinctly say that an old anterior wall MI is present on the ECG, there must be no identifiable R wave in lead V1 and usually V2 as well. [healio.com]
WPW preexcitation (negative delta wave may mimic pathologic Q waves) IHSS (septal hypertrophy may make normal septal Q waves "fatter" thereby mimicking pathologic Q waves) LVH (may have QS pattern or poor R wave progression in leads V1-3) RVH (tall R [ecg.utah.edu]
QT, RR, ST Intervals
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 [reliasmedia.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]
Complete Left Bundle Branch Block
The occurrence of a complete left bundle branch block at the end of the acute phase of a myocardial infarction reflects the presence of an extensive anterior infarction, which is a factor of poor prognosis and justifies an emergency reperfusion procedure [cardiocases.com]
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]
Abnormal Q waves and T-wave inversion in I and aVL. The pattern indicates prior infarction of the anteroseptal and lateral walls. [litfl.com]
V1 ST segment elevation Gaitonde (2003) Am J Cardiol 92:846-8 [PubMed] Biphasic or deep T Wave Inversion in V2, V3 ( Wellen's Syndrome ) High risk for left anterior descending artery ischemia and Anterior Wall Myocardial Infarction VIII. [fpnotebook.com]
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]
Biphasic T Wave
Left main coronary artery occlusion: widespread ST depression with ST elevation in aVR V1 Wellens syndrome: deep precordial T wave inversions or biphasic T waves in V2-3, indicating critical proximal LAD stenosis (a warning sign of imminent anterior infarction [litfl.com]
Left main coronary artery occlusion : widespread ST depression with ST elevation in aVR V1 Wellens syndrome : deep precordial T wave inversions or biphasic T waves in V2-3, indicating critical proximal LAD stenosis (a warning sign of imminent anterior [lifeinthefastlane.com]
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