Anterior wall

It is important to obtain a baseline EKG and cardiac enzymes to evaluate the possibility of an acute myocardial infarction. The short-term (2-4 weeks) stroke risk after acute myocardial infarction (AMI) is 2.5%. Stroke is usually an early (within 14 days) complication of AMI and is more common in anterior wall (4—12%) than in inferior wall infarction (1%). Approximately 40% of patients with an anterior wall myocardial infarction develop left ventricular thrombus. 

Recommended if patient is at high-risk of systemic thromboembolism (anterior wall infarction, heart failure, left ventricular thrombus, atrial fibrillation, previous embolism)... 

STE ACS, class I recommendation within the first 24 hours after hospital presentation for patients with anterior wall infarction, clinical signs of heart failure and those with EF less than 40% in the absence of contraindications, class I la recommendation for all other patients in the absence of contraindications. 

Sugiura T, Iwasaka T, Hasegawa T, et al. Factors associated with persistent and transient fascicular blocks in anterior wall acute myocardial infarction. Am. J. Cardiol. 1989 63 784-7. 

The biodistribution of intravenously injected allogeneic MSCs has been recently described [131]. Oxine-labeled MSCs were injected intravenously 72 h after occlusion/reperfusion in seven dogs. Initially, cells were trapped in the lungs within 24 h after injection, they had been redistributed into the liver and spleen. Focal uptake and persistence of the stem cells was observed in a mid anterior wall location corresponding to the infarcted target area. 

The preferred site for the instillation of eyedrops is the lower conjunctival sac (cul-de-sac). The anterior wall of this sac is the conjunctiva of the lower eyelid (palpebral conjunctiva), whereas the conjunctiva that covers the eyeball (bulbar conjunctiva) forms the posterior border, and the forniceal conjunctiva (the conjunctival bridge between bulbar and palpebral parts) lines the crater and the lateral borders of this space (Figure 24.1). 

To prevent bleeding, double clipping of the anterior wall in the anorectal region is performed using hemostats (Fig. 14.1A). 

Fig. 14.1. (A) Implantation of HT-29LP tumor cells into the posterior wall of the rectum. The anterior wall of the anorectal area is cut 7 mm in length between two hemostats to prevent colonic obstruction, resulting from tumor progression. Tumor cells are then injected submucosally using a 27 G needle. (B) At the end of the study period, the abdominal cavity is exposed through a midline incision and para-aortic lymph nodes (arrow), located around the abdominal aorta, are removed and imaged ex vivo.

Lunde KSS, Aakhus S, Arnesen H, Forfang K. Intracoronary injections of autologous mononuclear bone marrow cells in acute anterior wall myocardial infarction the ASTAMI randomized controlled trial, In Scientific Sessions of the American Heart Association 2005, Internet communication, 2006,... 

In 1972 we found that injections of propionitrile (Figure 1) consistently produced solitary, often perforating duodenal ulcers in the rat (5.). These lesions occurred 3-5 mm from the pylorus of the stomach, mostly - as in humans - on the anterior wall of the duodenum. The ulcers developed 24-48 h after the initial administration of propionitrile and frequently penetrated into the liver or pancreas ( ). 

The vaginal tract in the adult female is about 2 cm in width and consists of an anterior wall of about 8 cm in length and a posterior wall, about 11 cm in length (Figure 11.1). 

A 31-year-old man developed generalized discomfort after injecting four doses of amfetamine and metamfetamine over 48 hours, but no chest pain or tightness or shortness of breath. Electrocardiography showed inverted T-waves and left bundle branch block. Echocardiography showed reduced anterior wall motion. 

Y. Nakagawa, H. Ito, M. Kitakaze, H. Kusuoka, M. Hori, T. Kuzuya, Y. Higashino, K. Fujii, T. Minami-no, Effect of angina pectoris on myocardial protection in patients with reperfused anterior wall myocardial infarction retrospective clinical evidence of preconditioning , J Am Coll Cardiol 25, 1076-1083 (1995). 

M. Ishihara, H. Sato, H. Tateishi, T. Kawagoe, Y. Shimatani, S. Kurisu, K. Sakai, K. Ucda, Implications of prodromal angina pectoris in anterior Wall acute myocardial infarction acute angiographic findings and long-term prognosis, J Am Coll Cardiol 31, 1701 (1998). 

Therefore, often, the posterior wall does not exist and for this reason, the name inferior wall seems clearly better than the name inferoposterior . On the other hand, the anterior wall is, in fact, superoanterior, as is clearly appreciated in Figure 1.1 IB. However, in order to harmonise the terminology with imaging experts and to avoid more confusion, we consider that the names anterior wall and inferior wall are the most adequate for its simplification and also, because when an infarct exists in the anterior wall, the ECG repercussion is in the horizontal plane (HP V1-V6) and when it is in the inferior wall - even in the infer-obasal segment - it is in the frontal plane (FP). 

Both acute coronary syndromes (ACSs) and infarcts in chronic phase affect, as a result of the occlusion of the corresponding coronary artery, one part of the two zones into which the heart can be divided (Figure 1.14A) (1) the inferolateral zone, which encompasses all the inferior wall, a portion of the inferior part of the septum and most of the lateral wall (occlusion of the RCA or the LCX) (2) the anteroseptal zone, which comprises the anterior wall, the anterior part of the septum and often a great part of inferior septum and part of the mid-lower anterior portion of lateral wall (occlusion of the LAD). In general, the LAD, if it is large, as is seen in over 80% of cases, tends to perfuse not only the apex but also part of the inferior wall (Figures 1.1 and 1.14). 

Furthermore, there is an inferior infarction in cases of occlusion of a large LAD artery that wraps the apex. Usually, the Q waves are only observed in leads II, III and VF when the involvement of inferior wall is equal to or greater than anterior wall (Figure 5.16). In addition, a Q wave or an ST-segment elevation in V5-V6 indicates more inferoapical than anterolateral involvement (Warner et al, 1986). 

Figure 4.10 In an acute coronary syndrome with ST-segment elevation in V1-V2 to V4-V6 as the most striking pattern, the occluded artery is the left anterior descending coronary artery (LAD). The correlation of the ST-segment elevation in V1-V2 to V4-V5 with the ST morphology in II, III and VF allows us to know if it is an occlusion proximal or distal to D1 (see Figure 4.43). If it is proximal, the involved muscular mass in the anterior wall is large and the injury vector is directed not only forward but also upward, even though there can be a certain...

Figure 4.16 Acute myocardial infarction in a patient with rapid atrial fibrillation. The ECG shows ST-segment elevation in V2-V5, I and VL. Leads II, III, and VF present an evident ST-segment depression as a mirror pattern of ST-segment elevation in precordial leads. This is a pattern of acute coronary syndrome with ST-segment elevation of the anterior wall according to the classical classification.

The LAD perfuses the anterior wall and the anterior portion of the septum and great part of the inferior part of the septum and portion of the mid-low anterior part of the lateral wall (see p. 17). If, as frequently occurs ( 80%), it is a long artery that wraps the apex and perfuses part of the inferior wall (Figures 1.2 and 1.14), the first diagonal branch (Dl) and the first septal branch (SI) take off from the proximal portion of the LAD. Generally, the first diagonal branch (D1) is located below the first septal branch (SI). It is the opposite in almost 10% of the cases. 

The injury vector is directed anteriorly and to the right because the injury vector faces the anteroseptal area and often downwards (occlusion distal to Dl), especially if the LAD is long and wraps the apex, affecting part of the inferior wall. Then, if the anterior wall is not greatly affected because the occlusion occurs below a big Dl, the involvement of the inferior wall can turn out to be more important than the involvement of the anterior wall. The projection of this injury vector in the positive and negative hemi-fields of different leads of FP and HP explains the ST-segment elevation from VI to V4 and... 

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