A Study on Cardiac Rhythm Abnormalities in the First 48 Hours Following Acute Myocardial Infarction
Journal Title: Scholars Journal of Applied Medical Sciences - Year 2018, Vol 6, Issue 9
Abstract
Acute myocardial infarction is a major public health problem in developing countries. The incidence of coronary artery disease varies from 20-30 % of the cardiac cases admitted in any general hospital. Cardiac arrhythmias are frequent, serious complications of acute myocardial infarction and are associated with a 7 to 17 % increase in mortality. The extent to which arrhythmias are a direct cause of death in acute myocardial infarction has been estimated from clinical and pathological studies, but there has been little electrocardiographic documentation of the immediate pre-terminal rhythms. Despite several breakthrough treatment modalities have emerged, Arrhythmias is major cause of death in Acute Myocardial infarction(AMI), it still remains as a major cause of mortality and morbidity.The study aimed to study the nature and the types of arrhythmias occurring in the first 48 hours of acute myocardial infarction and to know the site of AMI. This descriptive observational study was conducted in the Cardiac ICU (coronary care unit) at Mahatma Gandhi Medical college Aurangabad, Maharashtra, India. 110 patients who presented with Acute Myocardial Infarction were studied. Detailed history was taken for each of these patients which included onset, nature of chest pain, aggravating relieving factors, risk factor, usage of oral contraceptives among females. Clinical examination in detail including ECG was recorded at the time of admission, hourly for first 6hours then 4 hourly for the next 42 hours. The various arrhythmias presented by the patients were documented. The central monitoring system was used to collect data among high risk patients. Routine investigations like complete blood count(CBC), blood sugar levels, fasting lipid profile were done. Specific investigations like CPK-MB (I&II) and TROPONIN-T & 2-D ECHO were carried out in selected cases.Patients with other complications of AMI and those with other cardiac pathologies were excluded from the study. Out of the 110 patients studied 85 were males and 25 werefemale with male: female ratio of 3.4:1 .Majority(80%) of patients with AMI were in the 5th to 7th decade and the incidence of arrhythmias as a complication of AMI was seen to increase with advancing age . In this study Anterior wall myocardial infarction(AWMI) was more common i.e, 48.17 % (n-53) than Inferior wall myocardial infarction (IWMI) 32.7% (n-36). Extensive Anterior is more common when compared to other AWMI. Incidence of cardiac arrhythmias increases with risk factors. Hypertension followed by smoking and were the most important risk factors both for AMI and arrhythmias. Brady-arrhythmias are more common in IWAMI 84.61% (n-11), while tachyarrhythmias are more common in AWAMI. AV block and Complete heart block(CHB) are more common with IWMI. The initial few hours post MI is critical for the development of arrhythmias with most of them occurin in the first 6 hours and two thirds in the first 12 hours post AMI. higher mortality is present in killip’s class IV patients. Thus, killip’s classification is good indicator to predict the prognosis of AMI patients. A major proportion of patients with AMI had arrhythmias of which majority presented in first 12 hours, implying the importance of monitoring in the first 48 hours. The patient who developed cardiac arrhythmias had deleterious ramifications on morbidity. Killip’s classification is good indicator to predict the prognosis of AMI patients.
Authors and Affiliations
Desai C. Rohit, Deshpande V. Ashish
Keywords
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