Atrial myocardial infarction: A tale of the forgotten chamber.
It has been almost a century since atrial infarction was first described, yet data describing its significance remain limited. To date, there are still no universally accepted criteria for the diagnosis of atrial infarction. Atherosclerosis is the leading cause of atrial infarction but it has also been described in cor pulmonale and pulmonary hypertension. Atrial infarction almost always occurs concomitantly with ventricular infarction. Its clinical presentation depends largely on the extent and site of ventricular involvement. Atrial infarction can present with supraventricular tachyarrhythmias. Electrocardiographic (ECG) criteria for diagnosing atrial infarction have been described but none have yet to be validated by prospective studies. Atrial ECG patterns include abnormal P-wave morphologies, PR-segment deviations, as well as transient rhythm abnormalities, including atrial fibrillation, atrial flutter, atrial tachycardia, wandering atrial pacemaker (WAP) and atrioventricular (AV) blocks. Complications of atrial infarction include thromboembolic events and cardiogenic shock. There are no specific additional recommendations in the management of myocardial infarction with suspected involvement of the atria. The primary goal remains coronary reperfusion and maintenance of, or conversion to, sinus rhythm.
Einstein Medical Center, Department of Medicine, Philadelphia, PA, United States.
Marvin Louis Roy
ML
Lu
Einstein Medical Center, Department of Medicine, Philadelphia, PA, United States.
Toni
T
De Venecia
Einstein Medical Center, Department of Medicine, Philadelphia, PA, United States.
Soumya
S
Patnaik
Einstein Institute for Heart and Vascular Health, Einstein Medical Center, Philadelphia, PA, United States; Sidney Kimmel College of Medicine at Thomas Jefferson University, Philadelphia, PA, United States. Electronic address: figueredov@einstein.edu.
Vincent M
VM
Figueredo
D004562:Electrocardiography / Q000379:methods / Q000639:trends; D006325:Heart Atria / Q000473:pathology* / Q000503:physiopathology*; D006801:Humans; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000503:physiopathology*; D011446:Prospective Studies
Atrial arrhythmia; Atrial infarction; Electrocardiogram; P wave; PR displacement