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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
- https://www.ahajournals.org/doi/10.1161/cir.0b013e3182742cf6
- https://www.sciencedirect.com/science/article/pii/S073510972106157X
- https://professional.heart.org/en/science-news/2021-acc-aha-scai-guideline-for-coronary-artery-revascularization
- https://pubmed.ncbi.nlm.nih.gov/15289388/
- 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
- https://pubmed.ncbi.nlm.nih.gov/28886621/
- https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Acute-Coronary-Syndromes-ACS-Guidelines
- https://academic.oup.com/eurheartj/article/39/2/119/4095042
- https://pubmed.ncbi.nlm.nih.gov/22922416/
- https://academic.oup.com/eurheartj/article/42/14/1289/5898842
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If you or your loved ones experience any of these symptoms, you should consult a doctor in time. Remember that self-medication can be dangerous, and timely diagnosis will preserve the quality and life expectancy.
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