Modern clinical retrospective on ventricular rhythm disturbances in acute myocardial infarction: Latest treatment mode according to the valid recommendations

Abstract

Ventricular arrhythmias are the most common cause of mortality in patients with acute myocardial infarction. Arrhythmias in acute coronary syndrome occur because of unbalanced function of the autonomic nervous system, because of electrolyte status disturbances (hypokalemia, hypomagnesaemia, intracellular hypercalcemia) and because of slow conduction in ischemical myocardium zones. Arrhythmias contribute to acidosis and release of free oxygen radicals occurring during reperfusion of ischemic myocardium. Ventricular arrhythmias in acute myocardial infarction indicate the presence of extensive myocardial damage at a reduced left ventricular ejection fraction, and not infrequently in the formation of an aneurysm of the left ventricle. In patients with acute coronary syndrome, the most common ventricular arrhythmias are premature ventricular beats, ventricular tachycardia, ventricular flutter and fibrillation and accelerated idioventricular rhythm. Ventricular fibrillation, still the leading cause of sudden death in patients with acute coronary syndrome within the first four hours of myocardial infarction, occurs in 80 % of all ventricular fibrillations. The use of beta-blockers in the first 24 hours of acute myocardial infarction in patients with early ventricular fibrillation and tachycardia does not affect the degree of worsening heart failure and is directly associated with reduced rates of early mortality in these patients. Quick and adequate treatment of ventricular arrhythmias is a major advancement in the treatment of acute myocardial infarction.