It has long been known that for normal growth and function inorganic salts must be supplied to all biological forms. Thus, Pasteur (1860) showed that yeast will grow only when the culture medium contains inorganic compounds¹. In the human body there is a tendency to maintain the proper fluid balance, not only as a whole but between the three compartments of intracellular, interstitial and intravascular spaces. This is maintained by an intricate play of hemodynamic, electrolyte and other forces. The field of mineral metabolism is at present in a phase of rapid expansion. It has become apparent that not only proteins, fats and carbohydrates, but also minerals are essential to life. Now the significance of traces not only of vitamins and other active organic substances, but also of minerals is under intensive investigation².

Magnesium has been implicated in the pathogenesis of acute myocardial infarct ion and its complications like arrhythmias. It plays a significant role in other cardiovascular diseases as well. Magnesium ions are considered essential for the maintenance of the functional integrity of the myocardium Infraction³.

Investigations revealed that magnesium level in the blood is decreased in the first 48 hours following a acute myocardial infarct ion and then increased steadily to reach the normal level in about three weeks time. The heart muscle subjected to myocardial infarct ion was found to contain a low magnesium concentration. These findings directly correlated with the resultant complications of myocardial infarct ion, such as arrhythmias.

Myocardial magnesium concentration in patients with sudden death due to ischemic heart disease was found to be very low. It has been pointed out that magnesium has a vital role in ventricular fibrillation, which causes sudden death in IHD. The coronary vasospasm resulting from magnesium deficiency has been suggested as another important factor in the sudden death of IHD. Magnesium deficiency was also postulated to have role in the genesis of atheromatous plaques in that it leads to hyper lipidemia. Also myocardial infarct ion is one of the common causes of death at present where prognosis depends on multiple factor of which many still remain unexplained⁴. This study is designed to know the relationship between serum magnesium levels and arrhythmias in patients with acute myocardial infarction.

MATERIALS AND METHODS

By using simple random method, 50 cases of acute myocardial infarct ion, admitted over a period of 2 years between October 2024 to March 2025. Those patients presenting to the hospital within 12 hours of onset of symptoms were taken. Patients were considered to have acute myocardial infarct ion including History of chest discomfort, ECG changes of acute myocardial infarct ion and rise of cardiac enzymes. Cases selected were subjected to a detailed history and thorough physical examination, routine investigation like hemoglobin, blood count , urine examination, blood sugar, blood urea, serum creatinine, serum electrolytes, fasting lipid profile, cardiac enzymes and echocardiography was per formed in all cases. Serum magnesium level were estimated on day-1 and day-5.

RESULTS

Age wise Distribution of Patients

Table.1 showed that the study group of 50 cases, the maximum incidence of acute myocardial infarct ion was seen above 5^th decade, followed by 4t h decade. 52% patients were in the age group of more than 5^th decade, 32% were in the age group of 40-49.

Table 1. Age wise Distribution of Patients

Sex wise distribution of Patients

Table 2 indicated that the study group of 50 cases, 33 was males and 17 were female patients with ratio of 1.63: 1. The study group contains 66% of male and 34% of females.

Risk Factors

In this study, smoking is the most common risk factor found in patients with acute myocardial infarct ion. Cigarette smoking accelerates coronary atherosclerosis in both sexes and at all ages and increases the risk of thrombosis, plaque instability and myocardial infarct ion. In addition by increasing myocardial oxygen needs and reducing oxygen supply it aggravates angina. In our study group 40% of subjects are smokers.

In the present study out of 50 patients, 28 (56%) were found to be obese based on National cholesterol education program. Circumference was measured in all patients, men whose waist

circumference is more than 102 cm and females whose waist circumference is more than 88cms were considered to be obese.

In the present study of 50 patients, 34 (68%) were found to be hypertensive. Patients whose blood pressure is more than 130/85 are considered to be hypertensive.

In the present study of 50 patients, 30 (60%) patients were found to be diabetic and 32 (64%) patients were found to be dyslipidemic. (Table.3)

Table.3. Risk Factors of acute myocardial infarction

Type of Myocardial Infarction:

In this present study of 50 patients, 22 (44%) had Anterior wall MI, 21(42%) patients had Inferior wall MI and 7 (14%) patients had Anteroseptal MI. (Table.4)

Serum Magnesium levels in Acute Myocardial Infarction in relation to Arrhythmia

Table.5 observed that the  cross sectional study of 50 patients, the mean serum magnesium level on day-1 in al l 50 patients was 1.88 + 0.26 and mean serum magnesium level on day-5 was 1.98 + 0 .47.  In the present study, out of 50 patients 28 patients had significant ventricular premature contract ions/ Ventricular tachycardia during their 5-days course in the hospital.

Table.6.  Serum Magnesium levels in Acute Myocardial Infarction

Arrhythmias in study group

In our study group of 50 subjects, 28 (56%) of patients developed arrhythmias and 22 (44%) of patients recovered without any complications. Arrhythmias included occasional VPCs and Ventricular tachycardia. The mean value of serum Magnesium levels on day -1 in those with arrhythmias is 1.70 +0.16, those without arrhythmias is 2.10 + 0.19 ( p<0.001). There is significant difference in patient with arrhythmias and without arrhythmias The above table shows that serum magnesium in patients with arrhythmias on Day 5 is 1.76 + 0.51 , those without arrhythmias is 2.26 + 0.20. There is a significant difference between these two (p <0.001).

Table.7 Comparison of mean magnesium level in patients with and without Arrhythmias

DISCUSSION

Magnesium ion has emerged as a premier cardiovascular cation during the decade. It has been implicated in the pathogenesis of acute myocardial infarct ion and complication like arrhythmias. Magnesium is essential for activation of AP, which maintains the sodium potassium pump and also because of calcium blocking action magnesium has been implicated in relation to arrhythmias after acute myocardial infarct ion. In the study group of 50 patients, 31 were males and 19 were females with a male- female ratio of 1.63:1. The maximum incidence of acute myocardial infarct ion was seen in the population more than 5^th decades.

In the present study of 50 patients, the mean serum magnesium level on day-1 in al l 50 patients was 1.88±0.26 and the mean serum magnesium level on day-5 was 1.98±0.47. Abraham et al13 reviewed magnesium level of 65 consecutive patients with an admission diagnosis of acute myocardial infarction. Serum magnesium concentration were low in patient who had AMI (mean 1.70 mg/dl , p<0.001) or acute coronary insufficiency (mean 1.61 mg/dl , p<0.01) , but not in the control group or patients with non - cardiac chest pain (mean 1.91 mg/dl) . Singh A et al75 checked serum magnesium levels of twenty patients of acute myocardial infarct ion on the 1^st , 7^th and  12^th day of admission. In al l the cases, there was a significant fall of serum magnesium on the first day.

Dimtruk et al⁵ in his series of 67 patients of ischemic heart disease showed a distinct reduction of plasma magnesium during the first 3 days fol lowing onset of disease, the level normal ized by 15 -25 days from onset of the disease.

Sachdev et al⁶ (1978) in 30 patients of myocardial infarct ion determine the magnesium levels within 24 hours, 5^th and 8^th  day and reported as 1.83±0.087mgs/dL, 1.91±0.149 and 1.97±0.089

as against control of 2.44±0.162 mgs/dL. The values were statistically lower on all the three days showing a progressive rise. In the present study, the serum magnesium level on day -1 was significant lower in patients with arrhythmias than those without arrhythmia (p<0.001). There was an increase in serum magnesium from Day-1 to Day-5 in both those with arrhythmias and those without arrhythmias.

Ceremuzynski et al⁷ assigned 48 patients with acute myocardial infarct ion over 24 hours infusion of magnesium or placebo. The incidence of ventricular tachycardia (3 or more consecutive premature ventricular contract ion at a rate faster than 120/ min) recorded by Holter monitoring was significantly reduced (p<0.001), but the incidence of other ventricular arrhythmias was not statistically different. Raismusen et al 21 randomized 273 patients with suspected acute myocardial infarct ion to intravenous magnesium or placebo. There is a significant decrease in the ventricular arrhythmia in the magnesium group compared to placebo (p<0.05) .

Shecter et al⁸ randomized 103 patients with documented acute myocardial infarct ion to 48 hours infusion of magnesium or placebo. There is a significant decrease in mortality (p<0.0 1). There was also a non-significant decrease in the number of tachy arrhythmias requiring treatment (10/50) in the magnesium group compared to control (24/53) .

Smith et al⁹ randomized 400 patients with suspected AMI to a 24 hours infusion of magnesium sulphate or placebo. Two hundred patients had confirmed acute myocardial infarct ion. The difference in mortality and incidence of ventricular dysarrhtymia requiring treatment between magnesium and placebo groups were not statistically significant.

Abraham et al¹⁰ randomly assigned 94 patients with acute myocardial infarction to receive a daily magnesium bolus of 30 mmol or placebo for 3- days. There was no significant difference in

mortality or lethal arrhythmias between patients treated with magnesium and those treated with placebo.

Liu et al¹¹ randomized 298 patients with suspected acute myocardial infarct ion to 24 hours infusion of magnesium or placebo. Myocardial infarct ion was documented in 162 patients. During the mean observation period of 245 days, there was no difference in the incidence of tachyarrhythmias, magnesium infusion was associated with a significant increase in bradyar rhythmias.

Singh et al¹² randomized 264 patients with suspected acute myocardial infarct ion to magnesium, potassium, 10% glucose or 2% glucose infusion. Myocardial infarct ion was confirmed in 228 patients. Mortality and ventricular tachycardia or fibrillation did not differ significantly between the magnesium group and placebo group.

Morton et al¹³ randomized 76 patients to receive either magnesium infusion 0.38 mmol / l per kg every 12 hour or placebo over the first 36 hours of hospital , there was no difference in the incidence of ventricular tachycardia.

Dyckner T et al¹⁴ during their 1½ years, 905 admission, 342 with acute myocardial infarct ion, 563 other diagnoses were treated in the CCU on admission both acute myocardial infarct ion and non AMI group had significantly lower serum magnesium level than as reference group. The incidence of serious ventricular premature beats, ventricular tachycardia and ventricular fibrillation on admission was significantly higher in the hypo magnesemic patients with acute myocardial infarction.

CONCLUSION

In the present study we conclude that the Serum Magnesium concentration were one of the prognostic and diagnostic biochemical marker for the acute myocardial infarction with and without Arrhythmias patients.

Declaration:

Conflicts of interests: The authors declare no conflicts of interest.

Author contribution: All authors have contributed in the manuscript.

Author funding: Nill

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