Anterolateral Myocardial Infarction (MI) on ECG

Introduction

Anterolateral myocardial infarction (MI) is a type of heart attack that affects the frontal and side walls of the left ventricle. It is a severe condition that requires rapid diagnosis and treatment.

ECG Findings in Anterolateral MI

1. Affected Leads:

  • ST-segment elevation in leads I, aVL, V3-V6.
  • Reciprocal ST depression in inferior leads (III, aVF, sometimes II).

2. Q Wave Formation:

  • Pathological Q waves may develop in the affected leads, indicating full-thickness myocardial injury.

3. T Wave Inversions:

  • As the infarction progresses, deep symmetrical T wave inversions can appear.

4. Reciprocal Changes:

  • ST depression may be seen in the opposite (inferior) leads like III and aVF.

Causes and Risk Factors

  • Coronary artery disease (CAD)
  • Hypertension
  • Diabetes mellitus
  • Smoking
  • High cholesterol

Immediate Management

  • Rapid revascularization via PCI (Percutaneous Coronary Intervention) or fibrinolysis.
  • Aspirin + P2Y12 inhibitors (clopidogrel, ticagrelor, or prasugrel).
  • Anticoagulation (heparin or enoxaparin).
  • Beta-blockers (if no contraindications).
  • Oxygen therapy (if hypoxic, SpO2 <90%).
  • Nitroglycerin (unless contraindicated by hypotension).

Conclusion

Anterolateral MI is a life-threatening condition that can be diagnosed using ECG. Recognizing ST-segment elevation in the appropriate leads and initiating immediate treatment can help save a patient's life.

Source recommendations

1. American Heart Association Guidelines for ST-Elevation Myocardial Infarction (STEMI)

  1. https://www.ahajournals.org/doi/10.1161/cir.0b013e3182742cf6
  2. https://professional.heart.org/en/science-news/2021-acc-aha-scai-guideline-for-coronary-artery-revascularization
  3. https://www.ahajournals.org/doi/10.1161/01.cir.0000134791.68010.fa
  4. https://pubmed.ncbi.nlm.nih.gov/23256914/
  5. https://www.heart.org/en/health-topics/heart-attack/treatment-of-a-heart-attack

2. European Society of Cardiology Guidelines on Acute Coronary Syndromes

  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://pubmed.ncbi.nlm.nih.gov/37622654/
  4. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001309
  5. https://pubmed.ncbi.nlm.nih.gov/32860058/

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