Atrial infarction is a unique and often unrecognized clinical entity

Abstract

A patient with heart failure and acute atrial fibrillation received the final diagnosis of atrial infarction associated with ventricular infarction based on clinical findings of ischemia in association with atrial fibrillation and heart failure (mechanisms probably involved: contractile dysfunction and loss of atrial contribution). Although a transesophageal echocardiography, which could refine the diagnosis of anatomic abnormalities, was not performed, all evidence led to the diagnosis of atrial involvement. Electrocardiographic findings were consistent with Liu's major criterion 3. Therapy with digitalis, quinidine and angiotensin-converting enzyme inhibitors was chosen, as the patient had acute pulmonary edema. The use of beta-blockers and verapamil was res-tricted. No other complications, such as thrombo-embolism or atrial rupture, were noted.

Left Atrial Infarction

“…2 However, since the underlying cause of left atrial infarction is coronary artery compromise, the diagnosis is often in association with a left ventricular posterior wall infarction. 2,3,5 An understanding of left atrial infarction requires knowledge of the blood supply to the left atrium. The right main and left circumflex coronary arteries, via their atrial rami, supply most of the blood to the left atrium.…”

“…However, atrial myocardial infarctions can and do occur, sometimes with fatal outcomes. [2][3][4][5][6][7][8][9] The accurate diagnosis of such infarctions is important in both the treatment of the acute event, understanding the symptomatology, and the prevention of morbidity and mortality. The anatomy of atrial circulation as well as the pathology and consequences of atrial infarction are discussed.…”

Acute regional left atrial ischemia causes acceleration of atrial drivers during atrial fibrillation

“…4–6 Atrial ischemia/infarction translates into PQ segment depression or elevation on the electrocardiogram and often associates with atrial tachy-arrhythmias. 4,5,7 In an experimental work, Sinno et al indicated that right atrial coronary branch occlusion resulted in severe conduction slowing and in an increased duration of AF episodes. 8 Also in a canine model, it was shown that acute occlusion of the right coronary artery led to atrial effective refractory periods shortening.…”