Background: Acute myocardial infarction (AMI) is a major cause of death worldwide with arrhythmia being the most common determinant in the post-infarction period. Identification and management of arrhythmias at an early period of acute MI has both short term and long term significance. Objective: The aim of the study is to evaluate the pattern of arrhythmias in acute STEMI in the first 48 hours of hospitalization and their inhospital outcome. Methods: A total of 50 patients with acute STEMI were included in the study after considering the inclusion and exclusion criteria. The patients were observed for the first 48 hours of hospitalization for detection of arrhythmia with baseline ECG at admission and continuous cardiac monitoring in the CCU. The pattern of the arrhythmias during this period & their in-hospital outcome were recorded in predesigned structured data collection sheet. Result: The mean age was 53.38 ± 10.22 years ranging from 29 to 70 years. Most of the patients were male 42(84%). Majority of the patients had anterior wall ( anterior, antero-septal & extensive anterior) myocardial infarction (54%). Sinus tachycardia in isolation was the most common arrhythmia observed in 36.8% of patients followed by sinus bradycardia (22.8%), ventricular tachycardia (19.3%), ventricular ectopic (12.3%),first degree AV block (5.3%), complete heart block and atrial ectopic 1.7% each. Tachyarrhythmias were more common in anterior wall myocardial infarction, whereas bradyarrhythmias were more common in inferior wall myocardial infarction. Among studied patients, 72% had favourable outcome , followed by acute left ventricular failure 10%, cardiogenic shock & lengthening of hospital stay 8% each and death 2%. Conclusion: The commonest arrhythmias encountered were sinus tachycardia followed by sinus bradycardia, ventricular tachycardia, ventricular ectopic, AV block and atrial ectopic. The incidence of mortality was 2%. University Heart Journal Vol. 16, No. 1, Jan 2020; 16-21

Acute coronary syndrome is a lethal condition. Treatment modality and success mostly depend on time yielded since onset of symptoms. It is known for more than 30 years that delay between symptom onset and treatment of less than 60 min are desirable, but pre hospital delays remain unacceptably long worldwide including Bangladesh. A greater understanding of the contributing factors may help to reduce delays. A number of sociodemographic, clinical, social and proximal factors have been associated with pre hospital delay. The total pre hospital delay period consists of two component: time taken by patients to recognize that their symptoms are serious and to contact medical help (decision time) and the time taken from requesting help to admission where emergency coronary care is available (time to hospital delay). Different factors may affect these two components. In hospital delay also known as door-to-treatment, is defined as time from arriving to hospital to initiation of reperfusion therapy. Regardless of how to shorten in hospital delay, if the pre hospital delay is not reduced, then reperfusion therapy cannot achieve the best results. We set out to discover what factors are specifically associated with three components: decision time, home to hospital delay and First Medical Contact (FMC) to revascularization delay. This review may help the National health management system to identify the factors associated with treatment delay in ACS and thus reduces ACS related morbidity and mortality. University Heart Journal Vol. 15, No. 2, Jul 2019; 79-85

Introduction:The basis of pathophysiologic benefit of revascularization is improving the function of viable myocardium 37 . Early coronary re-canalization helps to survive the viable myocardium and improve global LV function and survival 46 . According to the studies in patients with CAD and LV dysfunction, the disease outcome can be improved with surgical revascularization (CABG) or PCI 37 . PCI in patients with preserved LV function and optimal medical therapy doesn't reduce the cardiac death and MI, but it decreases the need for other procedure and the risk of angina. Its effect on LV systolic or diastolic function is not clear 31 . PCI has been used increasingly for revascularization in ischemic heart disease (IHD) patients. In most of the studies, the primary PCI, criterion such as ejection fraction (EF), diastolic function and the wall motion or chamber sizes has been investigated. But result of previous studies in related area, about elective PCI, has shown unequal viewpoints 1,6,13,27,30,32,39,41 . Intervals between MI and PCI, basic left ventricular ejection fraction (LVEF) before PCI and global condition of the patients affect the result of PCI. Angina occurs when there is regional myocardial ischemia caused by inadequate coronary perfusion and is usually but not always induced by A Study of Changes in Various Echocardiographic

Ventricular septal rupture (VSR) after acute myocardial infarction with the consequence of hemodynamic unstability is a rare complication and it's an medical emergency. Mortality of these group patients is higher than 90% to 95% without a rapid diagnosis and correction by surgical intervention.Spontaneous closure of VSR is extremely rare. We report the case of a patient with acute myocardial infarction with ventricular septal rupture (VSR) with cardiogenic shock that was diagnosed in our modern coronary care unit by the bed side portable echocardiographic machine (vivid).The incidence of ventricular septal rupture (VSR) after acute myocardial infarction is extremely rare in this reperfusion era.This condition is associated with a high mortality rate, even after the cardiac surgery . Our case emphasizes the risk factors and evolution of this condition.A 36 years old young hypertensive young man was admitted on 8 th August,2014 through the emergency department of university cardiac centre for central chest pain ,dyspnea, nausea and bilateral shoulder pain for the last last 7-8 days. He consulted with his family physician for the same complaints and later he was referred to get admission in our hospital. The patient's condition was detoriating gradually. Physical examination revealed a regular pulse of 110 beats/min. The blood pressure was 100/70 mmHg and there was a systolic murmur best heard at the apex, radiating to the axilla. . Pulmonary rales were present and there was no peripheral edema, hepatomegaly and raised JVP.The 12-lead electrocardiogram Figure 1) showed sinus rhythm at 125 beats/ min, low voltage QRS complex voltage in the limb leads, q waves in II,III, AvF and a 4 mm ST elevation in the anterior leads (V 2-4 ).Serum troponin T level at admission was 1.75 ng/ml, CK-MB 28 , Serun creatinine 1.25, Serum electrolytes are within normal limit.He was managed as a case of acute antero-septal MI with old inferior MI and on the following day after his admission he developed cardiogenic shock , examination reveals pulse was 115 beats/min and blood pressure was 80/40 mm of Hg.Then we put the patient under ionotrophic support ,transthoracic echocardiography was done and (figure 2,3 & 4) revealed a small rupture of the apical ventricular septum (figure 2) causing a VSR with left-to-right shunt (figure 3) and Doppler study showed the pressure gradient

Lutembacher's syndrome is a rare cardiovascular defect comprising of mitral stenosis and atrial septal defect. A combination of acquired mitral stenosis and congenital atrial septal defect is the most well-recognized pattern. As atrial septal defect acts as a pressure relieving gateway, signs and symptoms of mitral stenosis may be attenuated and/or delayed in such patients. We have presented a case with Lutembacher's syndrome that was incidentally diagnosed as having such defect during outpatient check-up for upper respiratory infection.