Cardiac Arrhythmias During Acute Myocardial Infarction



In the patient with acute myocardial infarction (MI), the clinician may encounter a variety of abnormal cardiac rhythms and conduction disturbances. The incidence of specific arrhythmias varies, depending on the time from onset of infarction (table 4-1). In order to catalog these rhythm disturbances, several classification schemes have been proposed. According to a modified version of the scheme developed by Lown in 1969, arrhythmias in patients with acute MI may be divided into three broad categories [1]:
  1. 1.

    Arrhythmias due to electrical instability.

  2. 2.

    Arrhythmias due to pump failure/excessive sympathetic stimulation.

  3. 3.

    Bradyarrhythmias and conduction disturbances.



Acute Myocardial Infarction Ventricular Tachycardia Ventricular Fibrillation Atrial Flutter Antiarrhythmic Agent 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Lown B: The philosophy of coronary care. Arch Klin Med 216: 201–241, 1969.PubMedGoogle Scholar
  2. 2.
    Bigger JT, Dresdale RJ, Heissenbuttel RH, et al: Ventricular arrhythmias in Ischemic heart disease: Mechanisms, prevalence, significance, and management. Progr Cardiovasc Dis 19: 255–300, 1977.CrossRefGoogle Scholar
  3. 3.
    Lown B, Wolf M: Approaches to sudden death from coronary heart disease. Circulation 44: 130–142, 1971.PubMedGoogle Scholar
  4. 4.
    Lie KI, Wellens HJJ, Durrer D: Characteristics and predictability of primary ventricular fibrillation. Eur J Cardiol 1:379, 1974.Google Scholar
  5. 5.
    Dhurandhar RW, MacMillan RL, Brown KWG: Primary ventricular fibrillation complicating acute myocardial infarction. Am J Cardiol 27:347, 1971.Google Scholar
  6. 6.
    Romhilt DW, Bloomfield SS, Chou TC, et al: Unreliability of conventional electrocardio-graphic monitoring for arrhythmia detection in coronary care units. Am J Cardiol 31:457, 1973.Google Scholar
  7. 7.
    Lie KI, Wellens, HJJ, van Capelle FJ, et al: Lidocaine in the prevention of primary ventricular fibrillation. N Engl J Med 291:1324, 1974.Google Scholar
  8. 8.
    Horwitz RI, Feinstein AR: Improved observational method for studying therapeutic efficacy. Suggestive evidence that lidocaine prophylaxis prevents death in acute myocardial infarction. JAMA 246: 2455–2459, 1981.PubMedCrossRefGoogle Scholar
  9. 9.
    Goldman L, Batsford WP: Risk-Benefit Stratification as a guide to lidocaine prophylaxis of primary ventricular fibrillation in acute myocardial infarction: An analytic review. Yale J Biol Med 52: 455–466, 1979.PubMedGoogle Scholar
  10. 10.
    DeSilva RA, Lown B, Hennekens CH, Casscells W: Lidocaine prophylaxis in acute myocardial infarction: An evaluation of randomised trials. Lancet 1: 855–858, 1981.Google Scholar
  11. 11.
    Thomson PD, Melman KL, Richardson JA, et al: Lidocaine pharmacokinetics in advanced heart failure, liver disease, and renal failure in humans. Ann Intern Med 78: 499–508, 1973.PubMedGoogle Scholar
  12. 12.
    Feely J. Wilkinson GR, McAllister CB, Wood AJJ: Increased toxicity and reduced clearance of lidocaine by cimetidine. Ann Intern Med 96: 592–594, 1982.PubMedGoogle Scholar
  13. 13.
    Taylor GJ, Crampton RS, Gibson RS, et al: Prolonged QT interval at onset of acute myocardial infarction in predicting early phase ventricular tachycardia. Am Heart J 102: 16–24, 1981.PubMedCrossRefGoogle Scholar
  14. 14.
    Rosen KM: Junctional tachycardia: Mechanisms, diagnosis, differential diagnosis and management. Circulation 47:654, 1973.Google Scholar
  15. 15.
    James TN: Myocardial infarction and atrial arrhythmias. Circulation 24: 761–776, 1961.PubMedGoogle Scholar
  16. 16.
    DeSanctis RW, Block P, Hutter AM: Tachyar-rhythmias in myocardial infarction. Circulation 45: 681–702, 1972.Google Scholar
  17. 17.
    Cristal N, Szwarcberg J, Gueron M: Supra-ventricular arrhythmias in acute myocardial infarction: Prognostic implication of clinical setting; mechanism of production. Ann Intern Med 82: 35–39, 1975.PubMedGoogle Scholar
  18. 18.
    Lie KL, Durrer D: Common arrhythmias in acute myocardial infarction. In: Cardiac arrhythmias: Mechanisms and management, Castellanos A (ed), Philadelphia, FA Davis Co, 1980, pp 191–201.Google Scholar
  19. 19.
    Lown B, Klein M, Hershberg P: Coronary and precoronary care. Am J Med 46:705, 1969.Google Scholar
  20. 20.
    Adgey AAJ, Geddes JS, Mulholland H, et al: Incidence, significance and management of early bradyarrhythmias complicating acute myocardial infarction. Lancet 2:1097, 1968.Google Scholar
  21. 21.
    Rotman M, Wagner GS, Wallace AG: Bradyarrhythmias in acute myocardial infarction. Circulation 45:703, 1972.Google Scholar
  22. 22.
    Webb S, Adgey AAJ, Pantridge JF: Autonomic dysfunction at onset of acute myocardial infarction. Br Med J 3:89, 1972.Google Scholar
  23. 23.
    Norris RM, Mercer CJ, Yeater SE: Sinus rate in acute myocardial infarction. Br Heart J 34:901, 1972.Google Scholar

Copyright information

© Martinus Nijhoff Publishing, Boston. 1986

Authors and Affiliations

  1. 1.Cardiovascular DivisionBrigham and Women’s HospitalBostonUSA
  2. 2.CardiologistGreen Lane HospitalAucklandNew Zealand

Personalised recommendations