Anterior Myocardial Infarction (AMI)

Introduction

Anterior myocardial infarction (AMI) is a severe form of heart attack that affects the front wall of the left ventricle. It is primarily caused by a blockage in the left anterior descending (LAD) artery, which supplies oxygen-rich blood to a large portion of the heart.

Causes and Risk Factors

  • Atherosclerosis (narrowing of arteries due to cholesterol buildup)
  • Blood clots blocking the LAD artery
  • Hypertension (high blood pressure)
  • Diabetes mellitus
  • Smoking
  • Obesity
  • Sedentary lifestyle
  • Family history of coronary artery disease

Symptoms

  • Severe chest pain radiating to the left arm, jaw, or back
  • Shortness of breath
  • Sweating
  • Nausea or vomiting
  • Lightheadedness or fainting

Diagnosis

  • Electrocardiogram (ECG): ST-segment elevation in the precordial leads (V1-V6) suggests an anterior MI.
  • Cardiac troponin levels: Elevated troponin indicates myocardial damage.
  • Echocardiogram: Assesses heart muscle function and wall motion abnormalities.
  • Coronary angiography: Identifies blockages in coronary arteries.

Treatment

Immediate Management

  • Aspirin and P2Y12 inhibitors (e.g., clopidogrel) to prevent further clot formation.
  • Pain relief with nitroglycerin or morphine.
  • Oxygen therapy if oxygen levels are low.
  • Primary Percutaneous Coronary Intervention (PCI): The preferred method to reopen blocked arteries using a stent.
  • Thrombolytic therapy: If PCI is unavailable within the optimal time frame.

Long-term Management

  • Beta-blockers and ACE inhibitors to reduce heart strain.
  • Statins to lower cholesterol.
  • Lifestyle modifications: Healthy diet, regular physical activity, smoking cessation.
  • Regular follow-ups with a cardiologist.

Prognosis and Complications

  • With prompt treatment, survival rates improve significantly.
  • Possible complications include heart failure, arrhythmias (irregular heartbeat), cardiogenic shock, or ventricular aneurysm.

Prevention

  • Control blood pressure, cholesterol, and glucose levels.
  • Maintain a healthy diet and exercise regularly.
  • Avoid smoking and excessive alcohol consumption.
  • Regular check-ups to monitor cardiovascular risk factors.

Source recommendations

1. American College of Cardiology/American Heart Association STEMI Guidelines

  1. https://www.acc.org/Guidelines
  2. https://www.ahajournals.org/doi/10.1161/cir.0b013e3182742cf6
  3. https://pubmed.ncbi.nlm.nih.gov/23256914/
  4. https://www.ahajournals.org/doi/10.1161/01.cir.0000134791.68010.fa
  5. https://www.jacc.org/doi/10.1016/j.jacc.2021.09.005

2. European Society of Cardiology STEMI Guidelines

  1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Acute-Coronary-Syndromes-ACS-Guidelines
  2. https://academic.oup.com/eurheartj/article/44/38/3720/7243210
  3. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines
  4. https://academic.oup.com/eurheartj/article/39/2/119/4095042
  5. https://pubmed.ncbi.nlm.nih.gov/37622654/

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