August 18, 2023

An ECG Cannot Rule Out Anterior Infarct

Anterior infarction is caused by a decrease in blood supply to the heart muscle. When your heart muscles are damaged, they release a special chemical called troponin. Troponin is detected with blood tests and can help doctors determine whether you’ve had a heart attack. Blood tests can also tell if your heart attack was triggered by exercise, which is important for getting the best treatment.

A 32-year-old woman gets an electrocardiogram (ECG) as part of her workup for epigastric pain and reflux symptoms. Her ECG shows ST segment elevation in leads V2-V3 and a loss of R waves in V1 and V2. These findings indicate that the patient may have had an anterior myocardial infarction, also known as an anterior wall myocardial infarction (AWMI).

However, the ECG cannot determine where the infarct happened in the patient’s heart. The AWMI was most likely caused by a sudden blockage of the left anterior descending (LAD) coronary artery. The LAD is one of the three primary heart arteries.

To diagnose a myocardial infarction, the healthcare team needs to take a detailed history and physical exam of the patient. This should include details about the onset of the problem, its severity and duration, and any associated symptoms. The patient’s history should also include risk factors for heart disease, such as family history of CAD, smoking, diabetes, hypertension, and obesity. The physical exam should be performed to look for clues such as chest pain, shortness of breath, tachypnea, jugular venous distension, and lung crackles.


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