Frequency of ventricular arrhythmias during first 24 hours of acute myocardial infarction in patient thrombolysed with streptokinase

ABSTRACT

To assess the frequency of ventricular arrhythmias during first 24 hours complicating first episode of Acute Myocardial Infarction in patients thrombolysed with Streptokinase. Cross-sectional, prospective, observational and qualitative study. This study was conducted at Sialkot Medical Complex for six months from March 2010 to August 2010. 200 consecutive patients with acute myocardial infarction who received Streptokinase were assessed for ventricular arrhythmias. Monitoring of the patients for ventricular arrhythmias for 24 hours from the time of admission was done. Arrhythmias from the cardiac monitor's memory noted and documented. Ventricular arrhythmias studied were ventricular fibrillation [VF], sustained ventricular tachycardia, accelerated idioventricular rhythm, non-sustained ventricular tachycardia and premature ventricular beats > 10 beats per hour. Findings were recorded on a specially designed proforma. The data were then entered in the computer for analysis and conclusions were drawn. Reperfusion arrhythmias were observed in 20% of the patients [40/200] in first 24 hours after thrombolytic therapy presenting with first acute myocardial infarction. All the patients included in the study showed the ECG criteria of STEMI and positive quantitatively Troponin T test. Inferior wall MI was the most common type of acute MI. All the patients received IV Streptokinase as thrombolytic agent. The patients with sustained VT [33%] received cardioversion and IV amiodarone. Non-sustained VT were managed by observation only [77%]. A total of 35 patients survived in first 24 hours, five died. Reperfusing arrhythmias are commonly observed in first 24 hours after Streptokinase therapy for acute myocardial infarctions. Most of the non-sustained reperfusion arrhythmias are left untreated and requires observation only but sustained ventricular arrhythmias [VF, VT] can be life-threatening and therefore must be considered for treatment, Electrical cardioversion is preferred over pharmacological treatment in case of sustained ventricular arrhythmias. Survival can be maximized if these arrhythmias are recognized and managed efficiently