Understanding Acute Anterior Wall Myocardial Infarction (AWMI) on ECG

Introduction

Acute Anterior Wall Myocardial Infarction (AWMI) is a severe type of heart attack that involves the front part of the heart (left ventricle). Recognition of AWMI on an electrocardiogram (ECG) is crucial for early diagnosis and treatment.

ECG Findings in AWMI

AWMI is typically caused by a blockage in the left anterior descending (LAD) artery, which supplies blood to the anterior part of the heart. On an ECG, characteristic features include:

• ST-segment elevation in the precordial leads (V1–V6), specifically in leads V2–V4 being the most pronounced.
• Reciprocal ST-segment depression in the inferior leads (II, III, and aVF).
• Pathological Q waves may develop in the anterior leads if the infarction is extensive.
• Hyperacute T waves, which are tall and broad, often appear in the initial phase.

Clinical Significance

• AWMI can lead to serious complications such as cardiogenic shock, ventricular arrhythmias, and heart failure.
• Early recognition is essential for rapid initiation of reperfusion therapy, such as percutaneous coronary intervention (PCI) or thrombolytic therapy.

Treatment Approach

1. Emergency Management:
   • Administer aspirin and P2Y12 inhibitors (e.g., clopidogrel, ticagrelor)
   • Provide oxygen, nitrates, and pain relief with morphine if needed
   • Start anticoagulation therapy (e.g., heparin)
2. Reperfusion Therapy:
   • Primary PCI is the preferred approach within 90 minutes of first medical contact.
   • If PCI is unavailable, fibrinolytic therapy (e.g., alteplase, tenecteplase) should be administered within 30 minutes.
3. Post-Intervention Care:
   • Use beta-blockers, ACE inhibitors, and statins to improve cardiac outcomes.
   • Monitor for complications like arrhythmias, left ventricular dysfunction, and reinfarction.

Conclusion

Recognizing AWMI on ECG is life-saving. Immediate treatment with reperfusion therapy significantly improves survival and reduces complications. If experiencing chest pain and ECG shows signs of AWMI, urgent medical intervention is vital.

Source recommendations

1. American Heart Association Guidelines for STEMI

1. https://www.heart.org/en/professional/quality-improvement/mission-lifeline/mission-lifeline-hospital-stemi-and-nstemi-recognition
2. https://www.ahajournals.org/doi/10.1161/cir.0b013e3182742cf6
3. https://www.heart.org/en/health-topics/heart-attack/treatment-of-a-heart-attack
4. https://www.ahajournals.org/doi/10.1161/01.cir.0000134791.68010.fa
5. https://professional.heart.org/en/science-news/2021-acc-aha-scai-guideline-for-coronary-artery-revascularization

2. European Society of Cardiology Guidelines for ST-segment Elevation Myocardial Infarction

1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Acute-Coronary-Syndromes-ACS-Guidelines
2. https://academic.oup.com/eurheartj/article/39/2/119/4095042
3. https://pubmed.ncbi.nlm.nih.gov/28886621/
4. https://academic.oup.com/eurheartj/article/44/38/3720/7243210
5. https://pubmed.ncbi.nlm.nih.gov/22922416/