Anterior Myocardial Infarction on ECG

Introduction

An anterior myocardial infarction (MI) refers to a heart attack affecting the front part of the left ventricle, usually due to a blockage in the left anterior descending (LAD) artery. Early recognition on an electrocardiogram (ECG) is crucial for timely treatment and better outcomes.

ECG Changes Indicative of Anterior MI

1. ST-Segment Elevation:

  • Seen in leads V1–V6 (depending on the extent of the infarct)
  • May also involve lead I and aVL, especially in extensive anterior MI

2. Reciprocal ST-Segment Depression:

  • Found in inferior leads (II, III, aVF) as a mirror reflection of ST elevations

3. Pathological Q Waves:

  • Develop over hours to days
  • Indicate irreversible myocardial necrosis

4. T-Wave Inversion:

  • Can appear later as the infarction evolves

Classification of Anterior MI

  • Septal MI: ST-elevation in V1–V2
  • Anteroseptal MI: ST-elevation in V1–V4
  • Extensive Anterior MI: ST-elevation in V1–V6, I, aVL
  • Apical MI: ST-elevation more prominent in V3–V4

Diagnosis and Immediate Management

Recognizing an anterior MI early is vital! - Urgent coronary angiography to assess the blocked artery - Primary percutaneous coronary intervention (PCI) is the gold standard treatment - Thrombolytic therapy if PCI is unavailable - Medications: Aspirin, P2Y12 inhibitors (clopidogrel, ticagrelor), anticoagulants, and beta-blockers (if no contraindications)

Conclusion

Anterior MI has a high risk of complications, such as heart failure, arrhythmias, and cardiogenic shock. Immediate ECG interpretation and early management significantly improve prognosis.

Source recommendations

1. American College of Cardiology/American Heart Association (ACC/AHA) ST-Elevation Myocardial Infarction Guidelines

  1. https://www.ahajournals.org/doi/10.1161/cir.0b013e3182742cf6
  2. https://www.sciencedirect.com/science/article/pii/S073510972106157X
  3. https://professional.heart.org/en/science-news/2021-acc-aha-scai-guideline-for-coronary-artery-revascularization
  4. https://pubmed.ncbi.nlm.nih.gov/15289388/
  5. https://www.acc.org/Guidelines

2. European Society of Cardiology (ESC) Guidelines for the Management of Acute Myocardial Infarction in Patients Presenting with ST-Segment Elevation

  1. https://pubmed.ncbi.nlm.nih.gov/28886621/
  2. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Acute-Coronary-Syndromes-ACS-Guidelines
  3. https://academic.oup.com/eurheartj/article/39/2/119/4095042
  4. https://pubmed.ncbi.nlm.nih.gov/22922416/
  5. https://academic.oup.com/eurheartj/article/42/14/1289/5898842

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