Study of Rhythm Disturbances in Acute Myocardial Infarction.

Introduction: Cardiac rhythm disturbances are common presentation in acute coronary syndromes and are cause of frequent serious complications in acute myocardial infarction (AMI). However due to availability of early reperfusion therapy and primary angioplasty, arrhythmias have cause a reduction in mortality. Arrhythmias are key events before, during or after the occurrence of acute MI. There are few clinical studies describing the types of arryhthmias, their correlation with the clinical profile of acute MI and effect on outcomes. In rural tertiary care centre, patients of acute MI, receive reperfusion therapy. The Indian population from central India is mostly a farming community from rural areas with limited medical aid resources. A tertiary care centre can only provide early reperfusion therapy in acute MI. There is very little data on rhythm disturbances in acute myocardial infarction from this geographic region.

Objectives: To study rhythm disturbances in acute myocardial infarction(AMI) and its effect on outcome.

Methods: All cases of acute ST elevation and non ST elevation MI having rhythm disturbances during reperfusion or ICU stay admitted between April 2012 to 2014.

Results: Rhythm disturbances were seen in 40-69 years of age. Chest pain (97%) and palpitation (63%) were commonest complaints. Hypertension was commonest risk factor. Sinus tachycardia (86%),ventricular ectopics (17%) and ventricular tachycardia (16%) were commonest tachyarrhythmias and sinus bradycardia (68%), right (23%) and left (18%)bundle branch blocks commonest bradyarrhythmias. Mortality was higher in tachyarrhythmias.

Conclusion: Compared to studies elsewhere it was observed that sinus tachycardia and bradycardia were commonest arrhythmias in AMI. That atrial fibrillation as observed in most studies elsewhere was not a common arrhythmia in this study. Mortality was statistically significant in tachyarrhythmias in both AWMI(55.71%) and IWMI(17.14%) as compared to bradyarrhythmias with p < 0.0001.