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Study of Various Cardiac Arrhythmias in Patients with Acute Myocardial Infarction Presenting to Emergency Department in A Tertiary Care Hospital

Pranay Krishna P, Assistant Professor, Department of Emergency & Critical Care Medicine, Narayana Medical College and Hospital, Chintared Dypalem, Nellore-524003, India. , Ravi Sankar V1 , Pranay Krishna P2 , Raghu Kondle3 , Manikanta Chaithanya L4 , Srikanth M5 , Satyanarayana V6

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Indian Journal of Emergency Medicine 6(3):p 173-184, July – September 2020. | DOI: http://dx.doi.org/10.21088/ijem.2395.311X.6320.5

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Ravi Sankar V, Pranay Krishna P, Raghu Kondle, et. al. Study of Various Cardiac Arrhythmias in Patients with Acute Myocardial
Infarction Presenting to Emergency Department in A Tertiary Care Hospital. Indian J Emerg Med 2020;6(3):173–184
 

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Abstract

Aim: Study aimed to study the pattern of various cardiac arrhythmias in
patients with Acute Myocardial Infarction (AMI) along with to study the
incidence of arrhythmia and their nature in relation with the site of infarction and to evaluate prognostic value of arrhythmias in Acute Myocardial Infarction during first 48 hours of hospitalization.

Method: The present study included 100 cases admitted in ED with chest pain and diagnosed as AMI between Oct 2015 and Nov 2017 in narayana medical college and hospital.


Results: In present study 78 cases were males with mean age of 56.33 ± 10.47and 22 were females with mean age of 59.82 ± 10.032. In present study 53% of cases were smokers, 50% patients had hypertension and 48% of patientswere diabetics. Most common site of infarction is Anterior wall followed by inferior wall. Incidence of AWMI was 57%, IWMI 36%, PWMI 4% andLWMI 3%. Most of the cases presented to ED within 8 hours of symptom onset. Most common presenting symptoms were chest pain and sweatings. In present study 61% & 79% of cases constitutes high risk group with TIMI
score ≥ 5 & HEART SCORE ≥ 8 respectively. Over all 58% of cases developed arrrhythmias, of which Tachyarrhythmias were the most common rhythm abnormality. But SB is the most common single arrhythmia type noted in the study and found to be statistically significant. In present study increased risk of arrhythmias were noted in smokers and diabetics. Statistically significant correlation was found between the incidence of arrhythymias and diabetes. Patients with LV dysfunction had increased risk of arrhythmias which was
found to be statistically significant and 53.5% of arrhythmias occurred within 4 hours of presentation to ED. Out of all arrhythmias 55.2% were seen in pre thrombolytic period, among post thrombolytic arrhythmias VPC’s were the most common type and most of them were persistent. In present study overall mortality was 7.0% and most common rhythm abnormality seen in these cases was VF(57.14%). All deaths due to arrhythmias were occured within 4 hours of arrival to ED and 85.71% of these were males and asociated with smoking and diabetes. These patients constitutes to high risk group with TIMI and HS ≥ 8.

Conclusion: Early recognition and management of arrhythmias can significantly modify the morbidity and mortality in AMI patients. All emergency ambulances should be equipped with defibrillators, 12-lead electrocardiographs and staffed with at least one person proficient in
advanced cardiac life support. ECG transmission/ teleconsultation may be useful in preventing delay in recognition and initiation of thrombolytics in AMI patients.


Keywords: Acute Myocardial Infarction; Cardiac Arrhythmias;
Emergency Department.

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Ravi Sankar V, Pranay Krishna P, Raghu Kondle, et. al. Study of Various Cardiac Arrhythmias in Patients with Acute Myocardial
Infarction Presenting to Emergency Department in A Tertiary Care Hospital. Indian J Emerg Med 2020;6(3):173–184
 

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DOI: http://dx.doi.org/10.21088/ijem.2395.311X.6320.5

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