{"id":53203,"date":"2023-12-31T11:08:12","date_gmt":"2023-12-31T11:08:12","guid":{"rendered":"https:\/\/biomedpharmajournal.org\/?p=53203"},"modified":"2024-01-05T06:29:16","modified_gmt":"2024-01-05T06:29:16","slug":"study-of-serum-magnesium-potassium-and-calcium-in-acute-myocardial-infarction-patients","status":"publish","type":"post","link":"https:\/\/biomedpharmajournal.org\/staging\/vol16no4\/study-of-serum-magnesium-potassium-and-calcium-in-acute-myocardial-infarction-patients\/","title":{"rendered":"Study of Serum Magnesium, Potassium and Calcium in Acute Myocardial Infarction Patients"},"content":{"rendered":"\n

Introduction <\/strong><\/p>\n\n\n\n

Ischemic heart disease is a term used for a group of closely related syndrome resulting from hypoxia to cardiac muscle. A myocardial infarction results when blood flow decreases or stops to the coronary arteries of the myocardium, resulting in damage to the cardiac muscle. Ischemia consists of not only insufficiency of oxygen, but also decreased availability of nutrient molecules and inadequate removal of metabolic products.1,2<\/sup><\/p>\n\n\n\n

 Hypomagnesemia is a common condition which is observed in 12-14% of patients admitted to hospital and occurrence of hypomagnesemia is as high as 60-65% in patients admitted in intensive care unit section. Magnesium plays vital part in decreasing arrhythmias during ischemic condition and also during reperfusion. Magnesium also helps in increasing the ventricular threshold of arrhythmias in normal condition.3,4<\/sup>  Potassium is the most abundant cation of intracellular fluid. A significant correlation between Hypokalemia and ventricular fibrillation is observed. Diuretics therapy in acute MI seems to be correlated with occurrence Hypokalemia but according to one study out of 100 patients with Hypokalemia and ventricular fibrillation only 30 were on diuretics therapy.5<\/sup>  Calcium performs very important functions in our body and deficiency calcium  manifests from asymptomatic to  life threatening conditions. Calcium plays an vital role in contraction myocardial muscle.6<\/sup>  Hence present study is undertaken to study serum levels of magnesium, potassium and calcium in acute myocardial infarction patients and compared with healthy controls.<\/p>\n\n\n\n

Material and methods <\/strong><\/p>\n\n\n\n

This was a\nprospective case control study conducted in Prathima Institute of medical\nsciences Nagunur, Karimnagar, Telangana state, India between January 2015 to\nDecember 2015.A total 50 acute myocardial infarction patients selected from\npatients admitted in intensive care unit ward and 50 normal age and sex matched\nhealthy controls selected from general population. Statistical analysis was\ncarried out using statistical software SPSS version 16 and p-value < 0.05\nwas considered statistically significant.<\/p>\n\n\n\n

Inclusion criteria<\/strong><\/p>\n\n\n\n

Cases: 50 acute myocardial infarction patients who were diagnosed by ECG and biochemical markers. Sample collected within 24 hours after diagnosis<\/p>\n\n\n\n

Controls : 50 normal age and sex matched healthy individuals <\/p>\n\n\n\n

Exclusion criteria <\/strong><\/p>\n\n\n\n

Cases of AMI on diuretic therapy<\/p>\n\n\n\n

Chronic diseases<\/p>\n\n\n\n

Diabetes mellitus<\/p>\n\n\n\n

Hypertension <\/p>\n\n\n\n

Collection\nof Blood Samples<\/strong><\/p>\n\n\n\n

About\n5ml of venous blood collected under aseptic conditions in plain vial for\nbiochemical tests at admission within 24 hours after diagnosis. Immediately\nafter collecting sample serum is separated and properly stored.<\/p>\n\n\n\n

The\nfollowing tests carried out in cases and controls.<\/p>\n\n\n\n

Serum Magnesium<\/p>\n\n\n\n

Serum Potassium<\/p>\n\n\n\n

Serum calcium<\/p>\n\n\n\n

Estimation of serum magnesium 7<\/sup><\/strong><\/p>\n\n\n\n

Serum magnesium\nestimated by  colorimetric xylidyl blue complex\nmethod. Magnesium ion forms a color complex with xyldyl blue under alkaline\nconditions. The intensity of the color developed is directly proportional to the\nmagnesium ion concentration in the sample.<\/p>\n\n\n\n

Estimation of serum Potassium<\/strong> 8<\/strong><\/sup><\/p>\n\n\n\n

Serum potassium\nestimated by ion selective electrode method. The ISE module for potassium\nemploys ether membrane electrodes. An electrical potential is developed\naccording to Nernst equation.  When\ncompared to internal reference solution electrical potential is translated into\nvoltage and then to the ion concentration of the sample<\/p>\n\n\n\n

Estimation of serum calcium<\/strong> 9-10<\/strong><\/sup><\/p>\n\n\n\n

Serum calcium\nestimated by OCPC method. Calcium ions reacts with o-cresopththalein complex in\nalkaline solution and forms an intense violet colored complex which is directly\nproportional to the calcium ion concentration<\/p>\n\n\n\n

Results <\/strong><\/p>\n\n\n\n

A total number of 100 subjects were included in the study of which 50 consist of cases and 50 were controls. Among 50 cases 42 were male and 8 were females and their mean age was 59.4\u00b11.6 years and among 50 controls 40 were male and 10 were females and their mean age was 58.3\u00b17.1 years.<\/p>\n\n\n\n\n\n\n\n
\n<\/td>\n\n

Study group<\/strong><\/p>\n<\/td>\n

\n

Control group<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

   Sex<\/strong><\/p>\n<\/td>\n

\n

  Male<\/strong><\/p>\n<\/td>\n

\n

   Female<\/strong><\/p>\n<\/td>\n

\n

            Male<\/strong><\/p>\n<\/td>\n

\n

   Female<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

    (n)<\/p>\n<\/td>\n

\n

    42<\/p>\n<\/td>\n

\n

      08<\/p>\n<\/td>\n

\n

              40<\/p>\n<\/td>\n

\n

      10<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n

Table 1: Comparison of Serum Magnesium, Potassium and calcium in Controls and acute myocardial infarction patients<\/strong>.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n
\n

Comparison of Serum Magnesium, Potassium and calcium in Controls and acute myocardial infarction patients<\/strong><\/p>\n

<\/p>\n<\/td>\n<\/tr>\n

\n

Groups<\/strong><\/p>\n<\/td>\n

\n<\/td>\n\n

Magnesium (mg\/dl)<\/strong><\/p>\n<\/td>\n

\n

Potassium
(mmol\/L)<\/strong><\/p>\n<\/td>\n

\n

Calcium  (mg\/dl)<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

Controls<\/p>\n<\/td>\n

\n

    Mean \u00b1 SD<\/p>\n

<\/p>\n<\/td>\n

\n

2.12 \u00b1 0.29<\/p>\n

<\/p>\n<\/td>\n

\n

4.63\u00b10.38<\/p>\n<\/td>\n

\n

9.46\u00b1 0.53<\/p>\n<\/td>\n<\/tr>\n

\n

Acute myocardial infarction <\/p>\n<\/td>\n

\n

Mean \u00b1 SD<\/p>\n<\/td>\n

\n

1.41 \u00b1 0.23<\/p>\n<\/td>\n

\n

3.61\u00b10.31<\/p>\n<\/td>\n

\n

7.64\u00b10.41<\/p>\n<\/td>\n<\/tr>\n

\n

Controls vs  Acute myocardial infarction <\/p>\n<\/td>\n

\n

Mean difference<\/p>\n<\/td>\n

\n

0.71<\/p>\n<\/td>\n

\n

    1.02<\/p>\n<\/td>\n

\n

1.82<\/p>\n<\/td>\n<\/tr>\n

\n

\n<\/p><\/td>\n

\n

t*<\/p>\n<\/td>\n

\n

13.54<\/p>\n<\/td>\n

\n

14.70<\/p>\n<\/td>\n

\n

19.20<\/p>\n<\/td>\n<\/tr>\n

\n<\/td>\n\n

 <\/em>P <\/em><\/p>\n<\/td>\n

\n

< 0.001<\/p>\n<\/td>\n

\n

< 0.001<\/p>\n<\/td>\n

\n

< 0.001<\/p>\n<\/td>\n<\/tr>\n

\n

* Unpaired t- test, P value < 0.001 considered as highly significant<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n

Table\n1 Shows biochemical characteristics of the study subjects. Serum mean level of\nMagnesium, Potassium and calcium were significantly (p< 0.001) decreased in\nacute myocardial infarction patients when compared to healthy controls. <\/p>\n\n\n\n

Discussion<\/strong><\/p>\n\n\n\n

 The findings from present study observed that,\nserum mean level of Magnesium, Potassium and Calcium were significantly (p< 0.001)\ndecreased in acute myocardial infarction patients when compared to healthy\ncontrols<\/p>\n\n\n\n

Magnesium is one of the vital mineral in body. Magnesium helps in myocardial metabolism, inhibits accumulation of calcium, improves vascular tone, improves cardiac output and reduces arrythmias 11<\/sup>. The mean serum level of magnesium decreased in acute myocardial infarction patients compared to healthy controls which is similar to study conducted by Choudhury MBK et al.12<\/sup> .<\/p>\n\n\n\n

   Patients diagnosed with acute myocardial infarction with concurrent hypomagnesium likely to have two to three fold increase in incidence of ventricular arrhythmia.13<\/sup> The exact reason for magnesium deficiency in patients with acute myocardial infarction is not clearly known.  According to one researcher low serum magnesium in acute myocardial infarction patients may be due shift of magnesium from extracellular to intracellular compartment.14<\/sup> according to another study there is a significant decrease in magnesium and potassium levels  due o the catecholamine induced circulating high free fatty acid levels causes  binding and  precipitation of  these minerals resulting  in sudden decrease in magnesium and potassium levels11<\/sup><\/p>\n\n\n\n

The mean serum level of potassium significantly decreased in acute myocardial infarction patients compared healthy controls. In previous studies a significant association between hypokalemia and ventricular arrhythmias demonstrated. Diuretics therapy given in myocardial infarction patients correlated with hypokalemia but out of 100 patients with hypokalemia who developed  ventricular fibrillation only 30  were on diuretics treatment. The likely reason for hypokalemia in the early phase of an acute myocardial infarction is seems to be associated with increased activation of the sympathetic nervous system causing influx of potassium from the extra cellular to the intracellular fluid compartment 15<\/sup><\/p>\n\n\n\n

Calcium performs very important functions in our body and is essential for cardiac function where it is required for myocardial contraction. Serum calcium level was significantly decreased in acute myocardial infarction patients when compared to healthy controls this is in accordance to study conducted by Kafka H et al.16<\/sup><\/p>\n\n\n\n

Deficiency of calcium in our body manifests from asymptomatic to life threatening disorders. Cardiovascular manifestations of calcium deficiency are prolonged QT interval, cardiac arrhythmias and failure of heart. However hypocalcaemia leading to occurrence of acute coronary syndrome or coronary artery spasm have been rarely reported 6,17<\/sup>.  According to one study low serum calcium is associated with cardiovascular risk factors such as hypertension, diabetes mellitus type 2 and left ventricular systolic dysfunction. This might be a contributing factor for higher cardiovascular mortality in the low calcium group.18<\/sup><\/p>\n\n\n\n

Limitation(s)<\/strong><\/p>\n\n\n\n

This\nstudy is carried out in small number of sample size; hence further study\ninvolving a larger sample size in different setup is needed for better understanding.<\/p>\n\n\n\n

Conclusion <\/strong><\/p>\n\n\n\n

In present study we have observed that there  is decreased levels of magnesium, potassium and calcium  in acute myocardial infarction patients when compared healthy controls and was statistically significant (<0.05).  Thus it is suggested from the above study that estimation and supplementation of magnesium, potassium and calcium may play a vital role in management of acute myocardial infarction patients. <\/p>\n\n\n\n

Conflict of Interest<\/strong><\/p>\n\n\n\n

There is no conflict of interest<\/p>\n\n\n\n

Funding Source<\/strong><\/p>\n\n\n\n

There is no funding sources<\/p>\n\n\n\n

References <\/strong><\/p>\n\n\n\n

  1. Kumar V, Abbas AK, Fausto N. Pathologic basis of disease (7th<\/sup> Edition). Philadelphia: Elsevier.2004;p572-581<\/li>
  2. \u201cWhat are the signs and symptoms of coronary heart disease? www.nhlbi.nih.gov.september 29, 2014. Archived from the original on 24 February 2015. Retrieved 23 February 2015.<\/li>
  3. Swaminathan R. Magnesium metabolism and its disorders. Clin.biochemical review. 2003;24(2): 47-66<\/li>
  4. Michael J. Dacey. Endocrine and metabolic dysfunction syndromes in the critically ill. Critical care clinics;volume 17 January 2001.<\/li>
  5. Clausen TG, Brocks K,  Ibsen H. \u201cHypokalemia and ventricular arrhythmia in acute myocardial infarction\u201d. Acta Med Scand. 1988;224(6):531-537
    CrossRef <\/a><\/li>
  6. Ujjwal K, Rupesh G. \u201chypocalcemia causing acute coronary syndrome\u201d. IHJ Cardiovascular case reports. 2020; CVCR(4): 135-137
     CrossRef <\/a><\/li>
  7. Korb J, Pribl R. Chem Listy.1957;51:1061 and Anal.Abst.1958;5:10
     CrossRef <\/a><\/li>
  8. Tietz NW. Editor fundamentals of clinical chemistry, 3rd<\/sup> edition, WB Saunders 1987<\/li>
  9. Connerty HV, Briggs AR. Am J. Clinical Pathology. 1966;45(290)
     CrossRef <\/a><\/li>
  10. Moorhead WR, Briggs HG. Clin Chem. 1981;27(1782).
     CrossRef <\/a><\/li>
  11. Md. Abdul Baset1, Md. Zahirul Haque, Md. Azizul Hoque, Shabyasachi Nath, Shah Mohammad Hassanur Rahman. \u201cSerum Magnesium Level in Acute Myocardial Infarction: A Study in Rajshahi Medical College Hospital, Rajshahi, Bangladesh\u201d Saudi J Med Pharm Sci, Jan., 2020; 6(1): 133-142
    CrossRef <\/a><\/li>
  12. Choudhury MBK, Rahman MS, Hassan MM, Begum R, Hoque N, Akhtaruzzaman M et. al. Comparision of serum magnesium and potassium in acute myocardial infarction and chronic ischemic heart disease. Journal Dhaka National Med. Coll. Hoss. 2011;17(01):33-36
    CrossRef <\/a><\/li>
  13. Henryk K, Lorrie LRN, Paul WA. Serum magnesium and potassium in acute myocardial infarction, influence on ventricular arrhythmias. Arch Intern Med. 1987;147(3):465-469
     CrossRef <\/a><\/li>
  14. Autman, E.M. Magnesium in acute myocardial infarction: Overview of the available evidence. heart J.1996; 132: 487-494
    CrossRef <\/a><\/li>
  15. Clausen TG, Bracks K, Ibsen H. Hypokalemia and ventricular arrhythmia in acute myocardial infarction. Acta Med Scand. 1988;224(6):531-537
     CrossRef <\/a><\/li>
  16. Kafka H, Langevin L, Armstrong PW. Serum magnesium and potassium in acute myocardial infarction. Arch Inter Med. 1987; 147:465-469
     CrossRef <\/a><\/li>
  17. Thongprayoon, C. et al. Hospital mortality and long-term mortality among hospitalized patients with various admission serum ionized calcium levels. Postgrad. Med.2020; 132, 385\u2013390.
    CrossRef <\/a><\/li>
  18. Timo Schmitz1, Christian Thilo, Jakob Linseisen, Margit Heier, Annette Peters, Bernhard Kuch et.al. Low serum calcium is associated with higher long term mortality in myocardial infarction patients from a population based registry.www.nature.com\/scientific reports. 2021; 11:2476
     CrossRef <\/a><\/li><\/ol>\n","protected":false},"excerpt":{"rendered":"

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