A study of the risk factors of various arrhythmias in patients with coronary heart disease
Keywords:Alcohol, Arrhythmias, Diabetes, Risk factors
Background: Complications like arrhythmias, cardiac failure, cerebrovascular and mechanical complications. Among these complications, arrhythmias are the most common complication of acute myocardial infarction. The objective of this study was to study the risk factors of various arrhythmias in patients with coronary heart disease.
Methods: Present study was a hospital based cross sectional study conducted at department of General Medicine of a tertiary care hospital for a period of two years among 102 patients. Detailed history, clinical examination, investigation was done. All patients were followed for one year to assess the outcome among them. All data was entered in the Microsoft Excel worksheet and analyzed using proportions.
Results: Arrhythmias were more common with low ejection fraction (72.73%). The overall mortality was 7.84%. Ventricular fibrillation was seen in 50% of the patients who did not receive thrombolytic therapy. First-degree AV block and second-degree AV block were present in 6.25% and 7.50% respectively and did not affect the mortality while complete heart block was present in 8.75% and mortality rate of 28.57% with right ventricular involvement. Risk factors like smoking, alcohol, hypertension, diabetes mellitus and obesity had higher incidence of arrhythmias but was not found to have any statistical significance (p >0.05). However, patients having multiple risk factors strongly associated with the high mortality in statistically significant manner (p value 0.0006).
Conclusions: Patients with risk factors like smoking, alcohol, hypertension, diabetes mellitus and obesity had higher incidence of arrhythmias. Multiple risk factors increase the incidence of both arrhythmias and mortality (67% mortality with 4 risk factors and 75% mortality with 5 risk factors).
Yadav P, Joseph D, Joshi P, Sakhi P, Jha RK., Gupta J. Clinical profile and risk factors in acute coronary syndrome. Natl J Community Med. 2010;1(2):150-2.
Ghuran AV, Camm AJ. Ischemic heart disease presenting as arrhythmias. BMB. 2001;59:193-210.
Yesil M. Management of arrhythmias during transportation in patients with acute myocardial infarction. Anatol J Cardiol. 2007;7(1):85-7.
Aufderheide TP. Arrhythmias associated with acute myocardial infarction and thrombolysis. Emerg Med Clin North Am. 1998;16(3):583-600.
Yap YG, Duong T, Bland M, Malik M, Torp-Pederson C, Kober L, et al. Temporal trends on the risk of arrhythmic versus non-arrhythmic deaths in high-risk patients after myocardial infarction: a combined analysis from multicentre trials. Eur Heart J. 2005;26(14):1385-93.
Macchia AJ, Leventesi G, Franzosi MG, Geraci E, Maggioni AP, Marfisi R, et al. Left ventricular systolic dysfunction, total mortality and sudden death in patients with myocardial infarction treated with n-3 PUFA. Eur J Heart Fail. 2005;7(5):904-9.
Ngarmukos T, Sriratanasthavorn C, Sansaneevithayakul B, Kasemsuwan P, Kitiporn A S, Yamwong S. Cardiac arrhythmias in thai: acute coronary syndrome registry. J Med Assoc Thai. 2007;90(Suppl 1):58-64.
Djousse L, Levy D, Benjamin EJ, Blease SJ, Russ A, Larsen MG, et al. Long-term alcohol consumption and the risk of atrial fibrillation in the Framingham Study. Am J Cardiol. 2004;93(6):710-3.
Yildirir A, Batur MK, Oto A. Hypertension and arrhythmia: blood pressure control and beyond. Europace. 2002;4:175-82.
Rana JS, Mukam KJ, Nesto RW, Morgan JS, Muller JE, Mittleman MA. Effect of diabetes mellitus and it’s treatment on ventricular arrhythmias complicating acute myocardial infarction. Diabet Med. 2005;22(5):576-82.
Hreybe H, Saba S. Location of acute myocardial infarction and associated arrhythmias and outcome. Clin Cardiol. 2009;32(5):274-7.
Henkel DM, Witt BJ, Gersh BJ, Jacobsen SJ, Weston SA, Meverden RA, et al. Ventricular arrhythmias after acute myocardial infarction: a 20-year community study. Am Heart J. 2006;151(4):806-12.
Samadikhah J, Hakim SH, Asl AA, Azarfarin R, Ghaffari S, Khalili A. Arrhythmia and conduction disorders in acute inferior myocardial infarction with right ventricular involvement. Rawal Med J. 2007;32:135-8.
Shabbir M, Kayani AM, Qureshi O, Mughal MM. Predictors of fatal outcome in acute myocardial infarction. J Ayub Med Coll Abbottabad. 2008;20(3):14-6.