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Anterior Wall MI Anterior Wall ST elevation MI (Example 1) Anterior Wall ST elevation MI (Example 2) Anterior Wall ST elevation MI (Example 3) Anterior Wall ST elevation MI (Example 4) Anterior Wall ST elevation MI (Example 5) Anterior Wall ST elevation MI (Example 6) Anterior Wall ST elevation MI with RBBB (Example) Old Anterior Wall MI (Example) An anterior wall myocardial infarction (AWMI) occurs when anterior myocardial tissue usually supplied by the left anterior descending artery (LAD) dies due to lack of blood supply. When an AWMI extends to the septal and lateral regions as well, the culprit lesion is usually more proximal in the LAD or even in the left main coronary artery. This large MI is termed an "extensive anterior". The EKG findings of an acute AWMI include: 1) ST segment elevation in the anterior leads (V3 and V4) and sometimes in septal and lateral leads depending on the extent of the MI. This ST elevation is concave downward and frequently overwhelms the T wave producing a "tombstoning" type appearance. 2) Reciprocal ST segment depression in the inferior leads (II, III and aVF). The EKG findings of an old AWMI includes: 1) Loss of anterior forces leaving Q waves in leads V1 and V2. This is sometimes termed "poor R wave progression" or PRWP. Note: To dinstinctly say that an old anterior wall MI is present on the EKG, there must be no identifiable R wave in lead V1 and usually V2 as well. If there is an R wave in V1 or V2, the term PRWP can be used, but not an old anterior wall MI. 2) On rare occasions, persistant ST elevation may be seen in V1 and/or V2 indicating a ventricular aneurysm (see the ventricular aneurysm section). |
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