ABSTRACT Background: Acute Myocardial Infarction (AMI) is a leading cause of cardiovascular mortality, with arrhythmias as significant complications. Infarction location influences the type and frequency of arrhythmias. Understanding these associations aids in risk stratification and management. Methods: This hospital-based, prospective observational study was conducted over 1.5 years at L.N. Mishra North Eastern Railway Hospital, Gorakhpur. A total of 100 AMI patients aged 19 years or older were included. Exclusion criteria were prior MI, valvular heart disease, and thyroid disorders. Data on infarction site, arrhythmia type, and risk factors were recorded using 12-lead ECGs and 2-D echocardiography. Statistical significance was set at p < 0.05. Results: Of the 100 patients, 74% were male, and 26% were female. AWMI (45%) and IWMI (30%) were the most common infarction sites. Arrhythmias occurred in 70% of patients, with sinus bradycardia (25.71%) and ventricular premature contractions (VPCs, 20%) being most frequent. VPCs were associated with AWMI, while sinus bradycardia and conduction blocks were linked to IWMI. Most arrhythmias occurred within the first hour (70%). Hypertension (38%) and diabetes (40%) were strongly correlated with arrhythmias. Conclusion: Infarction location significantly influences arrhythmia patterns in AMI, with AWMI linked to VPCs and IWMI to sinus bradycardia. Early monitoring and management of risk factors like hypertension and diabetes are essential. These findings highlight the need for infarction-specific monitoring and targeted interventions in AMI care.