The life-threatening condition of heart attack or myocardial infarction involves muscle damage through interruption in the blood supply of the heart. If this region involves the anterior part of the heart, it is referred to as anterior wall MI by Cardiologist in Karachi.
Read on to know more about anterior wall MI:
What is anterior wall MI?
Based on the coronary artery that is blocked, the adjacent region of the heart is affected. Anterior wall of the heart is affected when the tissue that is normally supplied by the left anterior descending coronary artery—LAD has reduced blood supply. Anterior wall myocardial infarction is also known as anterior segment ST elevation MI.
If the involved region spread to involve the lateral sides of the heart, then a different part of the vessel is affected, usually the starting bit of the left anterior descending, or even the left main coronary artery.
The diagnosis of the involved region of the heart, and the probable vessel blocked is made provisionally on the ECG findings, and the changes in the different leads of the EKG. In case of anterior wall myocardial infarction, the leads V3 and V4 commonly show changes, with reciprocal changes in inferior leads. The diagnosis is confirmed through additional testing and angiography studies.
What are the signs and symptoms of myocardial infarction?
Patients with anterior wall myocardial infarction present with:
- Pain just under the sternum that can be squeezing and burning in nature.
- Pain that radiates to the left arm, neck and chin.
- Heaviness in the chest
- Accompanying symptoms like nausea, vomiting, fatigue and palpitations.
- ‘Impending sensation of doom’ is a common feeling described by such patients.
- Anxiety, feeling faint and shortness of breath.
- Cold and clammy skin
Some people, particularly men can present with atypical symptoms of myocardial infarction such as:
- Pain in the upper back
- Jaw pain
- Shortness of breath.
What are the possible differential diagnoses?
Apart from heart attack, there can be other cardiovascular causes of chest pain, including:
- Aortic dissection
- Stable angina
- Aortic stenosis
Gastrointestinal causes that mimic heart attack include:
- Gastroesophageal reflux disease (GERD)
- Acute gastritis
- Spasm of the esophagus
- Acute pancreatitis
Other causes of chest pain include: muscular pain and pneumonia.
What are the risk factors of myocardial infarction?
The risk factors of anterior segment MI are divided into modifiable, and non-modifiable factors. The latter include factors like the age of the patient, the gender, race and family history.
The modifiable risk factors include:
- Hypertension: people with stress and hypertension tend to accelerate the hardening of vessels—atherosclerosis and the hypertrophy of heart muscle.
- Smoking: the risk of heart attack increases many-fold in people who smoke.
- Diabetes: individuals with uncontrolled diabetes have accelerated atherosclerosis as well as inflammatory changes in the body.
- Drug use: even younger individuals with history of recreational drug use, like cocaine have higher risk of heart attack.
- Physical inactivity: people who have a sedentary lifestyle tend to have higher blood pressure readings, weight, cholesterol and blood sugar levels in comparison to people who regularly work out.
How is the diagnosis made?
The diagnosis is made based on the history and investigations of the patient.
- 12-lead ECG: changes like ST-segment elevation are seen in cases of heart attack. However, heart attack cannot be ruled out even if the patient has normal ECG.
- Blood investigations:
- Complete blood count: this may show anemia—low hemoglobin count and high leukocyte count.
- Electrolytes: should be measured, especially potassium, as any disturbance in it, is linked to arrhythmias.
- Renal function tests (RFTs): should be measured especially before starting the drug called angiotensin converting enzyme (ACE) inhibitors.
- Cardiac enzymes: like troponins—T and I, creatine kinase (CK-MB) are raised following myocardial injury.
- C-reactive protein: CRP shows inflammation in the body which can occur due to muscle damage in MI.
- Chest x-ray: is done to assess the size of the patient’s heart and presence of heart failure through pulmonary edema.
- Serial ECG
What are the treatment options?
Early diagnosis and treatment, as that offered by healthcare providers at Fauji Foundation Hospital improves the outlook of patient with anterior wall MI.