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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

Diabetes mellitus adversely influences the outcome of acute coronary syndrome. This study evaluated the in-hospital outcome of acute coronary syndrome in patients with diabetes mellitus. In this prospective observation study 130 patients with acute coronary syndrome were enrolled. They were divided into diabetic and nondiabetic group. Diabetic patients were taken as case and nondiabetic patients as control. Outcome parameter studied were in-hospital mortality, cardiogenic shock, congestive heart failure, different arrhythmias and recurrent angina. In this study, one third (32%) of the patients were diabetic with mean age 58±10.0 years vs. 53.0±13.6 years in diabetic and nondiabetic group, respectively. Majority of the patients in both groups were male. Congestive heart failure and arrhythmias were more common in case group compared to those in control group (19% vs. 13.6% p=0.424; 23.8% vs. 13.6%, p= 0.148, respectively). Cardiogenic shock developed in 7.1% of diabetic patients and 8% of nondiabetic patients. In hospital mortality was 7.1% and 5.7% in diabetic and nondiabetic group, respectively. Recurrent angina developed only in diabetic patients. Therefore, diabetic patients with acute coronary syndrome encountered more in- hospital adverse outcome.   doi: 10.3329/uhj.v5i1.3437 University Heart Journal Vol. 5, No. 1, January 2009 24-27

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

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