ARRHYTHMIAS ASSOCIATED WITH ACUTE MYOCARDIAL INFARCTION AND THROMBOLYSIS - 09/09/11

Doi : 10.1016/S0733-8627(05)70019-5

Tom P. Aufderheide, MD, FACEP ^{^{*
Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin}}

Résumé

Cardiac arrhythmias are quite common in the setting of acute myocardial infarction. Ninety percent of patients with acute myocardial infarction (AMI) have some cardiac rhythm abnormality, and 25% have a cardiac conduction disturbance within 24 hours of infarct onset.^{4 Antman E.M., Braunwald E. Acute myocardial infarction Heart Disease: A Textbook of Cardiovascular Medicine Philadelphia: WB Saunders (1997).
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Cliquez ici pour aller à la section Références, 51 Meltzer L.E., Cohen H.E. The incidence of arrhythmias associated with acute myocardial infarction Textbook of Coronary Care Philadelphia: Charles Press (1972).

Cliquez ici pour aller à la section Références, 53 Norris N.M. Myocardial Infarction New York: Churchill Livingstone (1982).
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Cliquez ici pour aller à la section Références} The incidence (4.5%) of serious arrhythmias such as ventricular fibrillation (VF) is greatest in the first hour of an acute myocardial infarction and declines very rapidly thereafter.^{56 O'Doherty M., Tayler D.I., Quinn E. , et al. Five hundred patients with myocardial infarction monitored within one hour of symptoms Br Med J 1983 ; 286 : 1405-1408 [cross-ref]

Cliquez ici pour aller à la section Références} Almost all AMI patients initially exhibit increased autonomic nervous system activity, resulting in sinus bradycardia, sometimes associated with atrioventricular block or hypotension.^{4 Antman E.M., Braunwald E. Acute myocardial infarction Heart Disease: A Textbook of Cardiovascular Medicine Philadelphia: WB Saunders (1997).
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Cliquez ici pour aller à la section Références} With the advent of thrombolytic therapy, it was found that rhythm disturbances may actually be a marker of successful reperfusion.^{34 Goldberg S., Greenspon A.J., Urban P.L. , et al. Reperfusion of arrhythmia: A marker of restoration of antegrade flow during intracoronary thrombolysis for acute myocardial infarction Am Heart J 1983 ; 105 : 26 [cross-ref]

Cliquez ici pour aller à la section Références} The high incidence of identical rhythm disturbances in patients without successful coronary artery reperfusion limits specificity of arrhythmias for identifying restoration of coronary artery patency, however.^{14 Califf R.M., O'Neill W., Stack R.S. , et al. Failure of simple clinical characteristics to predict perfusion status after intravenous thrombolysis Ann Intern Med 1988 ; 108 : 658

Cliquez ici pour aller à la section Références} This article addresses the role and treatment of arrhythmias and conduction disturbances that complicate the course of patients with acute myocardial infarction and thrombolysis.

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Plan

Address reprint requests to Tom P. Aufderheide, MD, FACEP, Department of Emergency Medicine, 9200 West Wisconsin Avenue, Froedtert East, Milwaukee, WI 53226