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Anterior MI: Difference between revisions

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Anterior MI (view source)

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{{Chapter|Myocardial Infarction}}
{{Chapter|Myocardial Infarction}}
ECG-characteristics:<cite>Wung</cite>
ECG-characteristics:<cite>Wung</cite>
ST-elevation in leads V1-V6, I and aVL. Maximum elevation in V3, maximal depression in III
*ST-elevation in leads V1-V6, I and aVL. Maximum elevation in V3, maximal depression in III
later: pathological Q-wave in the precordial leads V2 to V4-V5.
*later: pathological Q-wave in the precordial leads V2 to V4-V5.
[[Image:heart_with_AL_infarct.png|thumb|Anterolateral infarct caused by occlusion of the LAD.]]
[[Image:heart_with_AL_infarct.png|thumb|Anterolateral infarct caused by occlusion of the LAD.]]
[[Image:stroomgebieden.png|thumb| The Left Anterior Descending (LAD) coronary artery is the most important coronary artery. On this mercatorprojection of the heart, the grey area is supplied by blood by the LAD and is at risk if this artery occludes.]]
[[Image:stroomgebieden.png|thumb| The Left Anterior Descending (LAD) coronary artery is the most important coronary artery. On this mercatorprojection of the heart, the grey area is supplied by blood by the LAD and is at risk if this artery occludes.]]
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*Little ST-segment depression (<= 1 mm) or elevation in II, III, and aVF (sens 66%, spec 73%)
*Little ST-segment depression (<= 1 mm) or elevation in II, III, and aVF (sens 66%, spec 73%)


Another way to look at this is by assessing the axix of the ST vector. If it points upwards (with ST depression in II, III, and AVF) the proximal LAD is occluded. If it points downwards (with little ST depression or even elevation in II, III, and AVF) the distal LAD is occluded. An ECG that does not show any ST depression sugggests an occlusion after the origin of the first diagonal branch.
Another way to look at this is by assessing the axis of the ST vector. If it points upwards (with ST depression in II, III, and AVF) the proximal LAD is occluded. If it points downwards (with little ST depression or even elevation in II, III, and AVF) the distal LAD is occluded. An ECG that does not show any ST depression sugggests an occlusion after the origin of the first diagonal branch.


A more precise determination of the location of the occlusion can be made with below table.<cite>Engelen</cite>
{|
! ECG criteria to determine site of LAD occlusion
|-
! Criterium
! Occlusion site
! Sensitivity
! Specificity
! PPV
! NPV
|-
| RBBB
| Proximal to S1
| 14
| 100
| 100
| 62
|-
| ST elevation in V1 > 2.5mm
| Proximal to S1
| 14
| 100
| 100
| 61
|-
| ST elevation in AVR
| Proximal to S1
| 43
| 95
| 86
| 70
|-
| ST depression in V5
| Proximal to S1
| 17
| 98
| 88
| 62
|-
| Q AVL
| Proximal to D1
| 44
| 85
| 67
| 69
|-
| ST depression in II > 1.0 mm
| Proximal to D1/S1
| 34
| 98
| 93
| 68
|-
| Q in V5
| Distal to S1
| 24
| 93
| 71
| 53
|-
| ST depression in AVL
| Distal to D1
| 22
| 95
| 87
| 46
|-
| Absence of ST depression in III
| Distal to S1/D1
| 41
| 95
| 92
| 53
|-
|}


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#Wung pmid=16777513
#Wung pmid=16777513
#Zimetbaum pmid=12621138
#Zimetbaum pmid=12621138
#Engelen pmid=10440150
</biblio>
</biblio>
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