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Anterior Myocardial Infarction

Myocardial Infarction (anterior Wall)

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 [1]. Across many studies, chest pain is identified as the most frequent finding, typically described as a burning or squeezing sensation [2]. It is seen in > 90% of patients [2] [3] [4]. 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 [2] [3] [4]. Radiation of pain is usually unilateral but individuals in whom bilateral spread occurred are also reported [2] [3 [4]. In the vast majority of cases, chest pain persists for more than 20 minutes [2]. In addition to pain, other common complaints include nausea, vomiting, dyspnea, shortness of breath, diaphoresis, abdominal pain, fatigue, dizziness, and palpitations [2] [3] [4]. Interestingly, some studies highlight that multiple features are more commonly encountered among women compared to men, without an obvious explanation [4].

Coronary Atherosclerosis
  • 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]
  • BACKGROUND: Acute Myocardial Infarction (AMI) is the leading cause of disability and death in Iran and many other countries. OBJECTIVE: To investigate the prognostic value of CCL5 and CCL18 in patients with acute myocardial ischemia.[ncbi.nlm.nih.gov]
  • "Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015".[en.wikipedia.org]
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]
  • 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]
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]
  • 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 intra-aortic balloon pump was withdrawn the following day and he was well enough to be discharged 7 days later. At 4 weeks he performed a satisfactory maximal exercise test and remains in New York Heart Association functional class I.[ncbi.nlm.nih.gov]
  • The dopamine drip was withdrawn completely by 72 hours. The ECG now displayed complete resolution of ST segments, normal QRS duration, and R waves from V2 to V6 ( Figure 12 ).[drdeepaknatarajan.com]
Renal Impairment
  • RESULTS: Women were older, were more commonly affected by hypertension and renal impairment, and had a 50.5-minute longer delay to reperfusion. There were no differences in infarct size, microvascular obstruction, or reperfusion success.[ncbi.nlm.nih.gov]
  • impairment and have normal blood potassium levels ( 5 mEq/L).[emedicine.medscape.com]
  • For a long time, the importance of right ventricle (RV) function has been neglected. Recently, RV dysfunction has also been associated with poor outcomes in the setting of heart failure.[ncbi.nlm.nih.gov]
  • There are premature atrial complexes (beat 4 on the rhythm strip) and multifocal ventricular ectopy (PVCs of two different types), indicating an “irritable” myocardium at risk of ventricular fibrillation.[lifeinthefastlane.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 [5] [6] [7] [8] [9]. 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 [6]. Creatine kinase myocardial band (CK-MB), initially used an equally important biomarker of cardiac injury [6], is now regarded as an unnecessary test due to its little value and accuracy [10]. For this reason, troponin remains the key biochemical exam [6] [7] [8] [9]. 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) [5] [11] [12]. Anterior myocardial infarction is confirmed when these findings are shown on the precordial leads V1-V4 [1]. In some patients, coronary angiography or other imaging studies of the heart can be used to further elucidate the severity of infarction [3].

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]
  • In this report, we present a patient who was admitted to our coronary care unit with acute anterior myocardial infarction (MI). 01) Anterior myocardial infarction was more frequent in patients with hyponatremia, who showed advanced Killip class.[medical-dictionary.thefreedictionary.com]
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 a cause of poor R wave progression, or PRWP.[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]
  • Poor R wave progression (R wave height 3mm in V3). Abnormal Q waves and T-wave inversion in I and aVL. The pattern indicates prior infarction of the anteroseptal and lateral walls.[lifeinthefastlane.com]
  • Hyperacute T waves are often “fat and wide” with poor R wave progression and blunt peaks, while hyperkalemic T waves are more often sharp with narrow base.[emdocs.net]
Short PR Interval
  • At the fourth day, while ST elevations returned to baseline, short PR interval and delta waves were observed on the ECG. Myocardial infarction was excluded by biochemical tests, echocardiography, and coronary angiography.[ncbi.nlm.nih.gov]
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]
  • 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]
  • Abnormal Q waves and T-wave inversion in I and aVL. The pattern indicates prior infarction of the anteroseptal and lateral walls.[lifeinthefastlane.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]
  • Two-thirds of MI's presenting to emergency rooms evolve to non-Q wave MI's, most having ST segment depression or T wave inversion. Most MI's are located in the left ventricle.[ecg.utah.edu]
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[lifeinthefastlane.com]
Electrocardiogram Change
  • Findings: Septal MI Anatomic Distribution Electrocardiogram Changes Lead V1 to lead V2 Distribution Left Coronary Artery : LAD-Septal Branch Complications Infranodal and Bundle Branch Block X.[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]


  • Anterior myocardial infarction carries the worst prognosis of all infarct locations, mostly due to larger infarct size.[lifeinthefastlane.com]
  • 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]
  • […] increased by 25% in the control group but 41% in the treated group with an anti-remodeling effect in the latter: LVEDV increased by 12% in the control vs 2% in the treated group (P Conclusions- The improvement of left-ventricular systolic function and prognosis[bloodjournal.org]
  • Prognosis correlates with the degree of myocardial necrosis. Greater degrees of myocardial necrosis are associated with a worse prognosis.[patient.info]


  • 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]
  • 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]
  • CAUSE (ETIOLOGY) OF MYOCARDIAL INFARCTION The most common cause of myocardial infarction is related to the formation of a blood clot (thrombosis) in a coronary artery.[calshipleymd.com]
  • Ischemic stroke etiologies vary, and may be from causes other than cardioembolism, such as large artery atherosclerosis or small-vessel lacunar disease.[journals.plos.org]
  • (See Etiology for details.) The electrocardiographic (ECG) results of an acute MI are seen below. Acute inferior myocardial infarction.[emedicine.medscape.com]


  • 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]
  • 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 [ 5 ] Coronary heart disease (CHD) is the most common cause of death in the UK. CHD is responsible for the deaths of approximately one in five men and one in ten women.[patient.info]
  • 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]
  • "Epidemiology of heart failure and left ventricular systolic dysfunction after acute myocardial infarction: prevalence, clinical characteristics, and prognostic importance".[en.wikipedia.org]
Sex distribution
Age distribution


  • 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]
  • Remember that the underlying pathophysiology of ACS is plaque rupture (usually in plaques less than 50%) with thrombus formation and platelet aggregation.[emdocs.net]


  • 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]



  1. Morris F, Brady WJ. Acute myocardial infarction—Part I. BMJ. 2002;324(7341):831-834.
  2. 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.
  3. Lu L, Liu M, Sun R, Zheng Y, Zhang P. Myocardial Infarction: Symptoms and Treatments. Cell Biochem Biophys. 2015;72(3):865-867.
  4. 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 .
  5. 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.
  6. 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.
  7. 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.
  8. Jaffe AS, Babuin L, Apple FS. Biomarkers in acute cardiac disease: the present and the future. J Am Coll Cardiol. 2006;48:1–11.
  9. 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.
  10. 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.
  11. 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.
  12. 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.

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Last updated: 2019-06-28 09:41