Download Serum Magnesium in Patients with Acute Myocardial Infarction

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DOI: 10.17354/ijss/2016/343
Origi na l A r tic le
Serum Magnesium in Patients with Acute
Myocardial Infarction
Lakshman Lal1, Hiralal Murmu2
Professor, Department of Biochemistry, Mahatma Gandhi Medical College, Jamshedpur, Jharkhand, 2Professor, Department of Medicine,
Mahatma Gandhi Medical College, Jamshedpur, Jharkhand, India
1
Abstract
Introduction: Magnesium is also known for its role in the electrical stability and energy balance of cardiomyocytes. Low serum
magnesium has been associated with accelerated atherosclerosis.
Aim: To estimate the level of serum magnesium in patients with acute myocardial infarction and compare with a normal healthy
adult.
Materials and Methods: A prospective study was conducted in the Department of Biochemistry at Mahatma Gandhi Memorial
Medical College, Jamshedpur. 40 patients with diagnosed case of acute myocardial infarction from Medicine Department were
selected for estimation of serum magnesium in Department of Biochemistry. 40 normal healthy adults of both sexes in the age
group of 30-79 years were selected for serum magnesium estimation as a control.
Result: Serum magnesium concentration in acute myocardial infarction group ranged from 0.42 to 1.56 meq/l with a mean
value of 1.01 meq/l and it is statistically significant (P < 0.01).
Conclusion: Within first 48 h after a heart attack, 80% of patients have hypomagnesemia. This could be the result of an
intracellular shift because of an increase in catecholamines.
Key words: Acute myocardial infection, Arrhythmia, Hypomagnesemia
INTRODUCTION
Hypomagnesemia is an electrolyte disturbance in which
there is low level of magnesium in blood.1 Magnesium
is an essential micronutrient for human beings and plays
an important role in normal myocardial physiology. It’s a
cofactor in more than 300 enzymes system of the body
in human cell. Its possible site of action includes vascular
smooth muscle, platelets, and myocardial cells.2 Magnesium
depletion can induce hyperlipidemia and subsequently
atherogenic deposits in coronary arteries leading to
atherosclerosis.3
Normal magnesium level fall between 1.7 and 2.2 meq/L.
Usually, a serum level <1.7 meq/L is taken as reference.
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Month of Submission : 04-2016
Month of Peer Review: 05-2016
Month of Acceptance : 05-2016
Month of Publishing : 06-2016
Hypomagnesemia may result from a number of conditions
including inadequate intake of magnesium, chronic
diarrhea, malabsorption, chronic stress, alcoholism, and
medication such as diuretic.4
Magnesium is of major importance in the treatment of
arrhythmia and coronary artery disease. Patients with
coronary heart disease (CHD) suffer from magnesium
deficiency. Oral combination therapy with magnesium
and potassium improves endothelial function in these
patients and reduce platelet dependent thrombosis.
Within the myocardial cell, low magnesium concentration
is associated with membrane destabilization, while high
magnesium concentration are membrane stabilizing
and therefore antiarrhythmic. Magnesium is a potent
vasodilator 5,6 and plays an important role in muscle
contraction. 7 CHD features among the indications
for oral magnesium therapy. It could be shown that
magnesium improves exercise duration and general
well-being in these patients. Individuals treated with
intravenous magnesium postinfarction were at significant
lower risk of dying from ischemic heart disease-related
complications.8,9
Corresponding Author: Dr. Lakshman Lal, 21 Ashashree Garde, Near RK Mission Ashram, Morabadi, Ranchi, Jharkhand, India.
E-mail: [email protected]
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Lal and Murmu: Serum Magnesium in Patients with Acute Myocardial Infarction
MATERIALS AND METHODS
Our study was undertaken in the Department of
Biochemistry, Mahatma Gandhi Medical College and
Hospital (MGM), Jamshedpur. Ethical approval was taken
from Institutional Ethics Committee of MGM. 40 patients
with diagnosed case of acute myocardial infarction were
selected for estimation of serum magnesium. The control
group comprised normal healthy individual of both sexes
in the age group of 30-79 years. An informed consent was
taken. Serum magnesium was estimated with Talmagite
Method.
RESULTS
The above Table 1 shows a significant decline in serum
magnesium concentration in the cases of acute myocardial
infarction, in comparison to healthy adult (control group).
In this study, serum magnesium was estimated in clinically
diagnosed case of acute myocardial infarction and healthy
adult of both sexes and different age group as the control
group.
Maximum numbers of patients with myocardial infarction
were in the age group 40-69 years. Out of 40 control cases,
25 cases belonged to 40-69 years of age. Serum magnesium
concentration in this group ranged from 1.6 to 3.0 meq/L
with a mean value of 2.20 meq/L. Out of 40 cases of acute
myocardial infarction, 29 cases belonged to 40-69 years of
age. 29 were males and 11 were females. A higher incidence
of myocardial infarction in male corroborates the fact
that incidence of ischemic heart disease is significantly
less in premenopausal women. The serum magnesium
concentration in acute myocardial infarction group ranged
from 0.42 to 1.56 meq/L with a mean value of 1.01 meq/L
and found to be statistically significant (P < 0.01).
DISCUSSIONS
Patients with acute myocardial infarction who have mild
hypomagnesemia appear to have two- to three-fold
increase in the frequency of ventricular arrhythmia in the
first 24 h when compared to those with normal plasma
magnesium level.10,11 Uncontrolled studies suggest that
Table 1: Comparison of serum magnesium in
control group with acute myocardial infarction
Serum magnesium
(meq/L)
Range
Mean±SD
Standard error of mean (±)
Control
group
Acute myocardial
infarction
1.60‑3.00
2.20±2.23
0.35
0.42‑1.56
1.01±0.94
0.14
“P” value for acute myocardial group was <0.01. SD: Standard deviation
the administration of intravenous magnesium at this time
can reduce the frequency of potentially fatal ventricular
arrhythmia.12,13
Magnesium is also known for its role in the electrical
stability and energy balance of cardiomyocytes.14 Low
serum magnesium has been associated with accelerated
atherosclerosis.15 QT prolongation is a well-established risk
factor for sudden cardiac disease,16 and serum magnesium
was shown to influence the QT interval in a clinical setting.17
The American Heart Association 1992 guidelines for
cardiopulmonary resuscitation and emergency cardiac care
now include a recommendation that magnesium sulfate be
added for the management of torsade de pointes, severe
hypomagnesemia, or refractory ventricular fibrillation.18
Torsade de pointes is a unique ventricular tachycardia most
commonly precipitated by drugs that prolong QT interval
(e.g., Quinidine), electrolyte imbalance (hypokalemia and
hypomagnesemia) or a slow heart rate and/or shortening
the QT interval. Intravenous magnesium is now regarded
as the treatment of choice even when hypomagnesemia
is not present.
Two large prospective epidemiologic studies have examined
the relationship between serum magnesium concentration
and the subsequent development of CHD.19 Both suggest
that low serum magnesium is a risk factor for CHD.
Mild hypomagnesemia is a common electrolyte
abnormality,20 particularly in the elderly who have increased
magnesium loss due to diuretic therapy or interstitial renal
disease. Magnesium regulates several cardiac channels
including the calcium channel and outward potassium
current through the delayed rectifier.21 Lowering the
cytosolic magnesium concentration in magnesium
depletion will markedly increase these outward currents,
shortening the action potential, and increasing susceptibility
to arrhythmia. A relationship has also been found between
the plasma magnesium concentration and ventricular
arrhythmia occurring in the second or 3rd week after
myocardial infarction.
In one study, for example, the mean plasma magnesium
concentration was 1.83 mg/dl (0.76 mmol/L) in patients
with no abnormal rhythm, 1.68 mg/dl (0.7 mmol/L) in
those with multifocal ventricular premature complexes
and 1.5 mg/dl (0.65 mmol/L) in those with unsustained
ventricular tachycardia. 22 13 patients with complex
arrhythmia and hypomagnesemia received IV magnesium
over 24 h, a normal rhythm was restored in ten.
Low serum magnesium has been implicated in cardiovascular
mortality, but results are conflicting. Total body magnesium
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Lal and Murmu: Serum Magnesium in Patients with Acute Myocardial Infarction
depends on dietary intake and recent studies showed
that vast majority of elderly do not consume the average
dietary requirement for magnesium.23 The prevalence
of magnesium in the general population is estimated
at 2%,24 but it may be as high as 53% in specific highrisk group such as patients with chronic heart failure.25
Although hypomagnesemia may have acute and chronic
complications, serum magnesium is still measured relatively
in frequently.26
In recent study, low serum magnesium has been associated
with inflammation27 and disturbance in the regulation
of vascular tone and endothelial function.28,29 These
mechanisms are thought to contribute to the development
and progression of atherosclerosis, potentially worsening
CHD.30
CONCLUSION
Magnesium influences endothelial function, inflammation,
blood pressure, and diabetes.31 With the first 48 hrs after
heart attack, 80% of patients have hypomagnesemia. This
could be the result of an intracellular shift because of an
increase in catecholamines.
REFERENCES
1.
Taylor EJ. Hypomagnesemia at Dorland’s Medical Dictionary. Philadelphia,
PA: Saunders; 2011.
2. Altura BM, Altura BT, Carella A, Turlapaty PD. Hypomagnesemia and
vasoconstriction: Possible relationship to etiology of sudden death ischemic
heart disease and hypertensive vascular diseases. Artery 1981;9:212-31.
3. Altura BM, Zhang A, Altura BT. Magnesium hypertensive vascular disease,
atherogenesis, subcellar compatmentation of Ca2+ and Mg2+ and vascular
contractility. Minor Electrolyte Meab 1993;19:323-36.
4. Romani AM. Magnesium in Health & Disease. Ch. 3. New York: Springer;
2013. p. 49-79.
5. Askar AO, Mustafa SJ. Role of magnesium in the treatment of cardiac
arrhythmias. Magnesium 2000;2:17-25.
6. Rasmussen HS, Larsen OG, Meier K, Larsen J. Hemodynamic effects of
intravenously administered magnesium on patients with ischemic heart
disease. Clin Cardiol 1988;11:824-8.
7. Shechter M, Kaplinsky E, Rabinowitz B. The rationale of magnesium
supplementation in acute myocardial infarction. A review of the literature.
Arch Intern Med 1992;152:2189-96.
8.
Casscells W. Magnesium and myocardial infarction. Lancet 1994;343:807-9.
9. Teo KK, Yusuf S. Role of magnesium in reducing mortality in acute
myocardial infarction. A review of the evidence. Drugs 1993;46:347-59.
10. Dyckner T. Serum magnesium in acute myocardial infarction. Relation to
arrhythmias. Acta Med Scand 1980;207:59-66.
11. Kafka H, Langevin L, Armstrong PW. Serum magnesium and potassium
in acute myocardial infarction. Influence on ventricular arrhythmias. Arch
Intern Med 1987;147:465-9.
12. Rasmussen HS, Suenson M, McNair P, Nørregård P, Balslev S. Magnesium
infusion reduces the incidence of arrhythmias in acute myocardial infarction.
A double-blind placebo-controlled study. Clin Cardiol 1987;10:351-6.
13. Abraham AS, Rosenmann D, Kramer M, Balkin J, Zion MM, Farbstien H,
et al. Magnesium in the prevention of lethal arrhythmias in acute myocardial
infarction. Arch Intern Med 1987;147:753-5.
14. Parikka H, Toivonen L, Naukkarinen V, Tierala I, Pohjola-Sintonen S,
Heikkilä J, et al. Decreases by magnesium of QT dispersion and ventricular
arrhythmias in patients with acute myocardial infarction. Eur Heart J
1999;20:111-20.
15. Orimo H, Ouchi Y. The role of calcium and magnesium in the development
of atherosclerosis. Experimental and clinical evidence. Ann N Y Acad Sci
1990;598:444-57.
16. Straus SM, Kors JA, De Bruin ML, van der Hooft CS, Hofman A,
Heeringa J, et al. Prolonged QTc interval and risk of sudden cardiac death
in a population of older adults. J Am Coll Cardiol 2006;47:362-7.
17. McBride BF, Min B, Kluger J, Guertin D, Henyan NN, Coleman CI,
et al. An evaluation of the impact of oral magnesium lactate on corrected
QT interval of patients receiving Sotalol or dafetilide to prevent atrial or
ventricular tachyarrhythmia recurrence. Ann Noninvasive Electrocardiol
2006;11:163-9.
18. Grillo JA, Gonzalez ER. Changes in the pharmacotherapy of CPR. Heart
Lung 1993;22:548-53.
19. Liao F, Folsom AR, Brancati FL. Is low magnesium concentration a risk
factor for coronary heart disease? The Atherosclerosis Risk in Communities
(ARIC) Study. Am Heart J 1998;136:480-90.
20. Schimatschek HF, Rempis R. Prevalence of hypomagnesemia in an
unselected German population of 16,000 individuals. Magnes Res
2001;14:283-90.
21. Agus ZS, Morad M. Modulation of cardiac ion channels by magnesium.
Annu Rev Physiol 1991;53:299-307.
22. Ceremuzynski L, Van Hao N. Ventricular arrhythmias late after myocardial
infarction are related to hypomagnesemia and magnesium loss: Preliminary
trial of corrective therapy. Clin Cardiol 1993;16:493-6.
23. Del Gobbo LC, Imamura F, Wu JH, de Oliveira Otto MC, Chiuve SE,
Mozaffarian D. Circulating and dietary magnesium and risk of cardiovascular
disease: A systematic review and meta-analysis of prospective studies. Am
J Clin Nutr 2013;98:160-73.
24. Liamis G, Rodenburg EM, Hofman A, Zietse R, Stricker BH, Hoorn EJ.
Electrolyte disorders in community subjects: Prevalence and risk factors.
Am J Med 2013;126:256-63.
25. Adamopoulos C, Pitt B, Sui X, Love TE, Zannad F, Ahmed A. Low
serum magnesium and cardiovascular mortality in chronic heart failure: A
propensity-matched study. Int J Cardiol 2009;136:270-7.
26. de Baaij JH, Hoenderop JG, Bindels RJ. Magnesium in man: Implications
for health and disease. Physiol Rev 2015;95:1-46.
27. Ishimura E, Okuno S, Yamakawa T, Inaba M, Nishizawa Y. Serum
magnesium concentration is a significant predictor of mortality in
maintenance hemodialysis patients. Magnes Res 2007;20:237-44.
28. Maier JA, Malpuech-Brugère C, Zimowska W, Rayssiguier Y, Mazur A.
Low magnesium promotes endothelial cell dysfunction: Implications for
atherosclerosis, inflammation and thrombosis. Biochim Biophys Acta
2004;1689:13-21.
29. Bernardini D, Nasulewic A, Mazur A, Maier JA. Magnesium and
microvascular endothelial cells: A role in inflammation and angiogenesis.
Front Biosci 2005;10:1177-82.
30. Amighi J, Sabeti S, Schlager O, Mlekusch W, Exner M, Lalouschek W,
et al. Low serum magnesium predicts neurological events in patients with
advanced atherosclerosis. Stroke 2004;35:22-7.
31. Song Y, Manson JE, Cook NR, Albert CM, Buring JE, Liu S. Dietary
magnesium intake and risk of cardiovascular disease among women. Am J
Cardiol 2005;96:1135-41.
How to cite this article: Lal L, Murmu H. Serum Magnesium in Patients with Acute Myocardial Infarction. Int J Sci Stud 2016;4(3):167-169.
Source of Support: Nil, Conflict of Interest: None declared.
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