Myocardial infarction anterior

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. 

Orotic acid or 6-methyluracil vide infra), when administered to rabbits with myocardial infarction induced by ligation of the anterior descending branch of the left coronary artery, can decrease the incidence of necrosis and increase the rate of regeneration for healthy cellular and fibrous connective tissue in the infarct region [182]. Rats with induced aortal stenosis which are treated with... 

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. 

A day after a dose of intravenous methylprednisolone 60 mg a 79-year-old woman developed acute thoracic pain and collapsed. An electrocardiogram showed signs of a myocardial infarction and her cardiac enzyme activities were raised. She died within several hours. Autopsy showed an anterior transmural myocardial infarction and mild atheromatous lesions in the coronary arteries. 

Abbreviations AMI, acute myocardial infarction LAD, left anterior descending LCX, left circumflex LMCA, left main coronary artery RCA, right coronary artery pt, patient. 

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,... 

Kuethe F Richartz BM, Sayer HG, et al. Lack of regeneration of myocardium by autologous intracoronary mononuclear bone marrow cell transplantation in humans with large anterior myocardial infarctions, Int J Cardiol 2004 97 123-127. 

Possible complications include massive myocardial infarction due to retrograde flow around the occlusion balloon, complete heart block, ventricular fibrillation, stroke, dissection of the left anterior descending artery, and right coronary artery thrombosis. Though high grade atrioventricular blockage occurs relatively frequently, procedural mortality rate is low (0-4%) and severe complications are rare and often avoidable (7-10). 

I/R = ischemia/reperfusion CA = coronary artery LV = left ventricle MI = myocardial infarction and LAD = left anterior descending branch of left coronary artery. 

A 73-year-old man with a history of breathlessness, cough, and weight loss had some ill-defined peripheral shadow in the upper zones of a chest X-ray. He had fiberoptic bronchoscopy with cocaine and lidocaine and 5 minutes later became distressed, with dyspnea, chest pain, and tachycardia. Electrocardiography showed an evolving anterior myocardial infarction. Coronary angiography showed a stenosis of less than 25% in the proximal left anterior descending artery with coronary artery spasm. He made an uneventful recovery. 

A healthy 33-year-old man with prior cocaine use had a small myocardial infarction and, 36 hours later, having inhaled cocaine, developed a dissection of the left main coronary artery, extending distally to the left anterior descending and circumflex arteries. There was marked anterolateral and apical hypokinesis. 

A retrospective chart review was conducted to explore metamfetamine-associated acute coronary syndromes in patients who presented to the emergency room at a University Center between 1994 and 1996 (1). There were 36 admissions, three of which were repeat patients. Nine of these patients had acute coronary syndrome. Of these, one had an acute anterior Q wave myocardial infarction with cardiac arrest, seven had non-Q wave myocardial infarctions, and one had unstable angina. There were potentially life-threatening cardiac complications in three subjects (8%). The authors suggested that acute coronary syndromes and life-threatening complications associated with the use of metamfetamine are not uncommon, as evidenced by their experience in this study. 

A 22-year-old man with a 6-year history of intravenous heroin use was maintained on methadone 60 mg/day and dihydrocodeine 0.5 g/day. He had an extensive anterior myocardial infarction as a result of occlusion of the left anterior descending coronary artery, which was reopened by percutaneous transluminal coronary angioplasty. 

Aortic arch dissection can cause profound hypotension, with global, and sometimes boundary zone, cerebral ischemia or focal cerebral ischemia if the dissection spreads up one of the neck arteries. Clues to this diagnosis are anterior chest or interscapular pain, along with diminished, unequal or absent arterial pulses in the arms or neck and a normal electrocardiogram, unlike acute myocardial infarction, acute aortic regurgitation and pericardial effusion. 

Timing of administration. The earlier thrombolysis is given the better the outcome. Treatment commencing within the first 3 h of onset is a realistic aim but thrombolysis up to 12 h is still worthwhile. Benefit is most striking in patients with anterior myocardial infarction treated within 4 h of onset. 

Forman, M.B. Perry, J.M. Wilson, B.H. Verani, M.S. Kaplan, P.R. Shawl, F.A. Friesinger, G.C. Demonstration of myocardial reperfusion injury in humans results of a pilot study utilizing acute coronary angioplasty with perfluorochemical in anterior myocardial infarction. J. Am. Coll. Cardiol 1991,75,911-918. 

A 29-year-old woman took bromocriptine 5 mg/day postpartum to suppress lactation (1). Four days later she developed an acute anterior myocardial infarction. Angiography showed dissection of the left main and anterior descending arteries, with occlusion of the latter. She recovered after emergency arterial grafting. 

A 22-year-old man snorted an 8 mg crushed tablet of buprenorphine and 2 hours later had crushing chest pain, which resolved within a few minutes (4). The symptom recurred 3 weeks later after another inhalation of buprenorphine. An electrocardiogram suggested an acute anterior myocardial infarction caused by buprenorphine-induced coronary artery spasm. 

A hypertensive crisis and myocardial infarction occurred in a 62-year-old woman after a combined injection of hydromorphone 48 mg and clonidine 12 mg subcutaneously in an attempt to refill an implanted epidural infusion pump (42). She was immediately treated with naloxone, but she subsequently had accelerated hypertension, a brief tonic-clonic seizure, and an anteroseptal myocardial infarction. Cardiac catheterization showed no coronary narrowing or blockage, but an anterior infarct was confirmed. 

A previously healthy 19-year-old man took tablets containing a total of 24 mg of Ephedra alkaloids and 100 mg of caffeine, and 15 minutes later developed severe chest pain radiating down the left arm. An electrocardiogram showed an inferolateral myocardial infarct, confirmed by creatine kinase and troponin I measurements. He made a full recovery, and coronary angiography showed only minimal atherosclerotic disease of the left anterior descending artery. 

A 42-year-old woman suffered an acute anterior myocardial infarction, initially associated with pulmonary edema. After hemodjmamic stabilization she was given lisinopril 10 mg oraUy. Two hours later she developed circulatory failure in conjunction with acute renal insufficiency. Right heart catheterization showed markedly reduced systemic vascular resistance but a normal cardiac index. After the usual causes of cardiogenic shock had been ruled out, repeated fluid challenges and intravenous noradrenaline failed to improve her hemodynamic status. She was therefore given angiotensin II intravenously (5-7.5 pg/minute), which immediately and markedly raised the systematic vascular... 

A 43-year-old woman with controlled hypertension, but no other known coronary risk factors, had an acute myocardial infarction. She took two oral doses of methysergide 2 mg 12 hours apart, followed by sumatriptan 6 mg subcutaneously. About 10 minutes after the sumatriptan, she complained of chest pain, and on arrival in hospital, an anterior myocardial infarction was diagnosed. Subsequent angiography showed a solitary stenosis in the left anterior descending coronary artery, and it was therefore presumed that she had suffered vasospasm associated with this stenosis. She made an excellent recovery after stenting. 

HPI BB is a 72-year-old man who presents to the ED with complaints of palpitations. PMH includes anterior myocardial infarction (Ml), hypertension (HTN), and depression. 

V. Marangelli, C. Memmola, M.S. Brigiani, L. Boni, M.G. Biasco, D. Scrutinio, S. Iliceto and P. Riz-zon, Early administration of verapamil after thrombolysis in acute anterior myocardial infarction. Effect on left ventricular remodeling and clinical outcome. VAMI Study Group. Verapamil Acute Myocardial Infarction, Ital Heart J. 1(5), 336-343 (2000). 

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). 

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