The Pattern of Cardiac Arrhythmias in Acute ST Elevated Myocardial Infarction and their in-hospital Outcome

Abstract

Background: Acute myocardial infarction (AMI) is a major cause of death worldwide with arrhythmia being the most common determinant in the post-infarction period. Identification and management of arrhythmias at an early period of acute MI has both short term and long term significance.
 Objective: The aim of the study is to evaluate the pattern of arrhythmias in acute STEMI in the first 48 hours of hospitalization and their inhospital outcome.
 Methods: A total of 50 patients with acute STEMI were included in the study after considering the inclusion and exclusion criteria. The patients were observed for the first 48 hours of hospitalization for detection of arrhythmia with baseline ECG at admission and continuous cardiac monitoring in the CCU. The pattern of the arrhythmias during this period & their in-hospital outcome were recorded in predesigned structured data collection sheet.
 Result: The mean age was 53.38 ± 10.22 years ranging from 29 to 70 years. Most of the patients were male 42(84%). Majority of the patients had anterior wall ( anterior, antero-septal & extensive anterior) myocardial infarction (54%). Sinus tachycardia in isolation was the most common arrhythmia observed in 36.8% of patients followed by sinus bradycardia (22.8%), ventricular tachycardia (19.3%), ventricular ectopic (12.3%),first degree AV block (5.3%), complete heart block and atrial ectopic 1.7% each. Tachyarrhythmias were more common in anterior wall myocardial infarction, whereas bradyarrhythmias were more common in inferior wall myocardial infarction. Among studied patients, 72% had favourable outcome , followed by acute left ventricular failure 10%, cardiogenic shock & lengthening of hospital stay 8% each and death 2%.
 Conclusion: The commonest arrhythmias encountered were sinus tachycardia followed by sinus bradycardia, ventricular tachycardia, ventricular ectopic, AV block and atrial ectopic. The incidence of mortality was 2%.
 University Heart Journal Vol. 16, No. 1, Jan 2020; 16-21

Arrhythmias in Patients With Acute Coronary Syndrome

“…This is regardless of the fact that different from previous investigations, we counted PVCs both manually and using a computer from the ECG data that was collected as soon as the patient was admitted in to the emergency department. The results from our study revealed that the males were predominantly the ones who suffered from arrhythmias which were similar to findings of a study conducted by Patil et al 16 who documented that males accounted for three-quarters or 75% of the total population suffering from arrhythmias. These results were in line with results from the studies conducted by Shlash RF et al 19 who also documented males to the more predominant gender amongst the population.…”

“…Another study indicate that statistically significant relationship between length of stay and PVCs was found on an independent level. 14 A few of the independent indicators included age in excess of 60 years and a predisposed AMI being diagnosed. 15 Arrhythmias was found to be in a much higher percentage for patients belonging to the 40 to 60 years age bracket in comparison to a similar study conducted by Patil et al 16 who documented that MI was more frequent in the age bracket of 50 to 60 years old.…”

Correlation of Prolonged Corrected QT Interval With Ventricular Arrhythmias and In-Hospital Mortality Among ST-Elevation Myocardial Infarction Patients: A Mystique or Lucidity?

“…These life-threatening VAs ultimately culminate into hemodynamic instability and the fatal demise of the patient. The morbidity and mortality due to VAs is declining in developed countries; however, its debilitating lethal manifestations are still a cause of major concern for cardiovascular morbidity and mortality in developing countries [6]. 1 2 2 3 3 3 3 3 3 1 The predictive factors of acquiring VAs in STEMI include advancing age, comorbidities, biochemical changes, structural heart disease, and congenital or acquired prolonged QT interval [7].…”

“…QT interval is the time slice of ventricular excitation and recovery represented from the initiation of the QRS complex to the termination of T wave on the ECG. Furthermore, the variations in heart rate cause significant alterations in the length of the QT interval and as a result, it is adjusted using the Bazett formula (QT/√RR interval) and referred to as corrected QT (QTc) interval [6][7][8]. The standard QTc interval of below 450 milliseconds (ms) in males and 460 ms in females represents normal ventricular conduction [8].…”

“…These life-threatening VAs ultimately culminate into hemodynamic instability and the fatal demise of the patient. The morbidity and mortality due to VAs is declining in developed countries; however, its debilitating lethal manifestations are still a cause of major concern for cardiovascular morbidity and mortality in developing countries [ 6 ].…”