Serum magnesium levels in type 2 diabetic patients presenting with acute coronary syndrome and prevalence of cardiac arrhythmias in these patients

Hypomagnesaemia have been reported to occur with an increased frequency in type 2 diabetics compared with their counterparts without diabetes. Abnormalities of magnesium levels, such as hypomagnesaemia, can result in disturbances in nearly every organ system and can cause potentially fatal complications [e.g., ventricular arrhythmia, coronary artery vasospasm, sudden death]. Premature ventricular complexes [PVC] predict cardiovascular mortality among several adult populations. This study was done to find correlation between serum magnesium levels of diabetics and incidence of arrhythmias. We analyzed the serum magnesium levels in fifty consecutive patients with type 2 diabetes presenting with acute coronary syndrome in CCU of Services Hospital, Lahore and prevalence of cardiac arrhythmias in these patients. Serum magnesium levels were measured at presentation and twenty four hour Holter monitoring was done for the detection of arrhythmias. There were 33 male [66%]; 17 female [34%] patients and mean age of presentation was 60 years [ +/- 20 years]. 7 [14%] out of 50 patients had hypomagnesaemia [<1.7mg/dl], 2 females and 5 males. 'Ventricular premature contractions' in hypomagnesemic patients were 1.5 times the patients with normal magnesium level. There was no definite relationship observed between serum magnesium level and 'supraventricular premature contractions'. Although ventricular premature contractions are more common in patients with hypomagnesaemia and may result into life threatening arrhythmias but no life threatening arrhythmias [e.g., ventricular tachycardia and torsade de pointes] were seen in our study population with hypomagnesemia

Does radiofrequency ablation increase creatine kinase and troponin-T?

Radiofrequency ablation produces a focal area of myocardial necrosis. Creatine kinase (total & MB fraction) and troponin-T were analysed in 54 patients who underwent electrophysiological study and radiofrequency ablation for atrioventricular nodal reentrant tachycardia, atrioventricular reentrant tachycardia and idiopathic ventricular tachycardia. The age of the patients was 36 +/- 12 years; 17 patients underwent slow pathway modification for atrioventricular nodal reentrant tachycardia, 26 patients underwent accessory pathway ablation and 11 patients underwent ablation for idiopathic ventricular tachycardia. There was no significant rise in creatine kinase, creatine kinase total & MB fraction and troponin-T in the patients who underwent slow pathway ablation for atrioventricular nodal reentrant tachycardia. In patients with atrioventricular reentrant tachycardia, there was no significant rise in creatine kinase and creatine kinase total & MB fraction levels, while troponin-T levels rose from 0.13 +/- 0.06 to 0.29 +/- 0.16 eta g/ml (p < 0.05). There was an increase in creatine kinase, creatine kinase total & MB fraction and troponin-T levels after idiopathic ventricular tachycardia ablation from 68.4 +/- 44.9 to 138.0 +/- 81.7 IU (p < 0.05), 2.77 +/- 3.34 to 25.2 +/- 19.8 IU (p < 0.05) and 0.09 +/- 0.04 to 0.34 +/- 0.08 eta g/ml (p < 0.001) respectively. Radiofrequency ablation of atrioventricular nodal reentrant tachycardia does not cause any significant myocardial damage to raise any cardiac enzymes. Ablation of atrioventricular reentrant tachycardia results in only minor injury causing rise in only troponin-T levels. However, ventricular tachycardia ablation results in significant myocardial injury raising all the cardiac enzymes.

Reciprocal ST segment depression in acute myocardial infarction.

The significance of "reciprocal" ST segment depression and the utility of this finding in the electrocardiogram (ECG) of patients with myocardial infarction were studied in 100 cases of acute myocardial infarction. Out of these, 30 cases expired with 20 cases (66.6%) showing reciprocal ST depression in the ECG. In the remaining 70 cases, 24(34.3%) had reciprocal ST changes while 46(65.7%) had not. Twenty (83.3%) out of 24 cases had inferior wall infarction. The incidence of complications in the form of complete heart block and mortality was higher in the patients with reciprocal changes. The creatinine kinase levels were significantly elevated in patients with reciprocal changes than in the patients without. Predischarge treadmill test done in these cases having reciprocal changes showed positive stress tests. Coronary angiography was performed in the cases with reciprocal ST-T changes which revealed the presence of double-vessel disease or triple-vessel disease in most of these cases.

Effect of aspirin treatment on plasma levels of keto PGF 1 alpha and thromboxane B2.

A study was carried out on the effect of aspirin 175 mg/day on the plasma levels of 6 keto PGF 1 alpha and TXB2 in patients with acute myocardial infarction and in patients subjected to coronary artery bypass surgery. Our results showed a fall in the levels of both the prostagladins from day one to day seven and further from seven to day nine in patients with myocardial infarction treated with aspirin 175 mg/day. In patients with myocardial infarction accompanied by arrhythmias the TXB2 levels dominated over the 6 Keto PGF 1 alpha levels. In the group of patients subjected to coronary bypass surgery but after treatment with aspirin 175 mg/day for a period of five days both 6 keto PGF 1 alpha and TXB2 levels fell significantly.

Changes in 6 keto PGF1 alpha and TXB2 in patients with myocardial infarction.

A study was carried out on the plasma levels of 6 Keto PGF1 alpha and Thromboxane B2 (TXB2) in patients with acute myocardial infarction. Our results showed a generalized increase in the levels after acute myocardial infarction. The 6 Keto PGF1 alpha levels increased twice as compared to control values while the TXB2 levels increased nine times as compared to control values. The prostaglandin levels were found to increase from day 1 to day 3 and further from day 3 to day 7. In most of the patients with uncomplicated myocardial infarction the 6 Keto PGF1 alpha levels were higher than the TXB2 levels. In patients with myocardial infarction accompanied by arrhythmias the TXB2 levels dominated over the 6 Keto PGF1 alpha levels.

Incidence of malignant cardiac dysrythmias in relation to serum potassium level in patients with acute myocardial infarction

The objective was to study the relationship between varying levels of potassium at hospital admission and cardiac dysrhythmias in patients with acute MI. This study included the potassium values and ECG evaluations for 470 patients [376 males and 94 females]. Serum potassium levels on admission were related to certain supraventricular and ventricular dysrhythmias with special interest in VF