Vol. 7, Issue 1, Part C (2025)

Background: Acute Coronary Syndrome (ACS) is one of the life-threatening manifestations of ischemic heart disease (IHD) ranges from ST-Segment Elevation Myocardial Infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI) and unstable angina. Ventricular arrhythmias were frequently complicates the ACS patients in response to electrolytes imbalance.

Objectives: Considering the hypokalemia, the main objective of the study was to find out the prevalence of hypokalemia and its association in ventricular arrhythmias in ACS patients.

Methods: This hospital based observational cross sectional study was conducted in the department of cardiology in DMCH over 1-year period. Patients with ACS admitted in the CCU of DMCH were approached for inclusion in this study. Total 200 newly diagnosed ACS patients who fulfilled the inclusion and exclusion criteria were taken as study subjects. The study subjects were divided into 2 groups, patients with low potassium level (Plasma potassium level <3.5 mmol/L) were considered as Group A and patients with normal potassium level (3.5-5 mmol/L) were considered as Group B. Within 12 hours of admission of the patients, serum potassium, magnesium and calcium levels were done.

Results: The mean age of the studied patients was 56.4±9.9 years. Among the study subjects 38(19%) patients with hypokalemia were in group A and 162(81%) patients with normal potassium level were in group B. Mean potassium level with ventricular arrhythmias was 3.6±0.9mmol/l and in those without ventricular arrhythmia it was 4.2±0.7mmol/l (P-0.001). Ventricular Tachycardia (VT), Ventricular fibrillation (VF) and significant premature ventricular complexes (PVCs) occurred higher (34.2% vs. 9.9%, P=0.001), (13.2% vs. 3.7%, P=0.02) and (18.4% vs. 7.4%, P=0.03) in group A than group B respectively. Ventricular arrhythmias were developed higher (59.1%) in severe hypokalemia (<2.5mmol/l) than lower (30.6%) in mild hypokalemia (>2.5mmol/l) with p-value <0.05. Frequency of different arrhythmias (65.8%) is higher in group-A than group-B (21%). In multiple logistic regression analysis revealed age, hypertension, diabetes mellitus and hypokalemia were found to significantly associated with the development of arrhythmias with the ORs being 1.64, 2.58, 2.60 and 6.17 respectively, p-value <0.5. Whereas gender, smoking, f/h of CAD, dyslipidemia and obesity were higher in ORs but not statistical significant difference, p>0.5. Pearson’s correlation revealed strongly negative correlation between serum Potassium level and developing of arrhythmias with r=-0.95 and p<0.001.

Conclusion: Early attention to serum potassium level in ACS patients is needed to prevent and treat ventricular arrhythmias which reduced hospital adverse outcome in these patients.