Chiwhane Anjalee
Professor, JNMC, Sawangi Wardha, Maharashtra; *Corresponding Author.
Professor, JNMC, Sawangi Wardha, Maharashtra.
J Assoc Physicians India. 2018 Jan;66(1):54-8.
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.
To study rhythm disturbances in acute myocardial infarction(AMI) and its effect on outcome.
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.
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.
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.
心律失常是急性冠状动脉综合征的常见表现，也是急性心肌梗死（AMI）常见严重并发症的原因。然而，由于早期再灌注治疗和直接经皮冠状动脉腔内血管成形术的应用，心律失常已使死亡率有所降低。心律失常是急性心肌梗死发生之前、期间或之后的关键事件。很少有临床研究描述心律失常的类型、它们与急性心肌梗死临床特征的相关性以及对预后的影响。在农村三级医疗中心，急性心肌梗死患者接受再灌注治疗。印度中部的人群大多是来自农村地区的农业社区，医疗救助资源有限。三级医疗中心只能在急性心肌梗死中提供早期再灌注治疗。关于这个地理区域急性心肌梗死心律失常的数据非常少。
研究急性心肌梗死（AMI）中的心律失常及其对预后的影响。
纳入2012年4月至2014年期间收治的所有在再灌注期间或重症监护病房（ICU）住院期间出现心律失常的急性ST段抬高型和非ST段抬高型心肌梗死病例。
心律失常见于40 - 69岁人群。胸痛（97%）和心悸（63%）是最常见的主诉。高血压是最常见的危险因素。窦性心动过速（86%）、室性期前收缩（17%）和室性心动过速（16%）是最常见的快速性心律失常，窦性心动过缓（68%）、右束支传导阻滞（23%）和左束支传导阻滞（18%）是最常见的缓慢性心律失常。快速性心律失常患者的死亡率更高。
与其他地方的研究相比，观察到窦性心动过速和窦性心动过缓是急性心肌梗死中最常见的心律失常。在本研究中，正如其他大多数研究中所观察到的房颤并非常见心律失常。与缓慢性心律失常相比，急性后壁心肌梗死（AWMI）（55.71%）和急性前壁心肌梗死（IWMI）（17.14%）快速性心律失常患者的死亡率具有统计学意义，p < 0.0001。
