European Journal of Cardiovascular Medicine

Acute myocardial infarction is one of the most common causes of hospitalization as well as one of the most common causes of death. [1] Up to three million people worldwide are afflicted with the illness, which has an incidence of 64.37/1000 in India. [2] And a very high chance of passing away in the initial hours following the onset of symptoms. AMI results from an imbalance between the required and accessible oxygen levels, which damages and finally kills the heart muscle's muscle cells.[3] The two subtypes of AMI are ST-segment elevation MI (STEMI) and non-ST-segment elevation MI (NSTEMI). Unstable angina and NSTEMI are similar. [4] Acute myocardial infarction has been linked to a number of risk factors, including age, family history, smoking, serum cholesterol, diabetes, and hypertension. Many factors can lead to the production of reactive oxygen species (ROS). These ROS are frequently transformed into less reactive compounds by the use of antioxidants. Healthy cells have equilibrium of antioxidants and the appropriate pro-oxidants (ROS). Nonetheless, the balance may shift in favor of pro-oxidants if the production of oxygen species is markedly increased or antioxidant levels are decreased. Extensive or protracted stress is referred to as "oxidative stress" and can result in irreversible cell damage. Electrolyte abnormalities are common in patients suffering from acute myocardial infarction (AMI), and they have been associated with unfavorable clinical outcomes. Unbalances in electrolytes, especially those pertaining to potassium, sodium, magnesium, and calcium, can cause difficulties with cardiac rhythm and function as well as increase the chance of deaths and other conditions such heart failure and arrhythmias. AMI and electrolyte abnormalities have been studied extensively. Another study indicated that low magnesium levels were an independent predictor of early death in AMI patients. Furthermore, hypernatremia, or low sodium levels, has been connected to an increased risk of death and a higher prevalence of heart failure in AMI patients. Hyperkalemia, or elevated potassium levels, has also been linked to an increased risk of arrhythmias and cardiac arrest in individuals with AMI.

Study design: Prospective Case Control Study

Place of study: Katihar Medical College.

Period of study: July 2022 to December 2023

Sample size: 60

Inclusion criteria:

• All cases, admitted in the medicine ward of KMC, Katihar during the study period, with an established diagnosis of AMI by clinical profile, ECG and Echocardiography and by Cardiac Biomarkers.

Exclusion criteria:

• Patients on potassium Sparing Diuretics.
• Liver Disease
• Diarrhea and Vomiting
• Diabetes mellitus patients on insulin therapy
• Adrenal Insufficiency

STUDY MATERIAL

• Clinical history and physical examination
• Drug history like use of potassium sparing diuretics, insulin and beta agonists.
• Electrolyte levels (Sodium and Potassium)

[Normal Sodium level 135-145 mEq/L. Normal Potassium level-3.5-5.4 mEq/L]

• Standard 12 lead ECG.
• Cardiac bio markers [CK-MB and cardiac troponin T test]
•  

Statistical Analysis:

For statistical analysis, data were initially entered into a Microsoft Excel spreadsheet and then analyzed using SPSS (version 27.0; SPSS Inc., Chicago, IL, USA) and Graph Pad Prism (version 5). Numerical variables were summarized using means and standard deviations, while categorical variables were described with counts and percentages. Two-sample t-tests, which compare the means of independent or unpaired samples, were used to assess differences between groups. Paired t-tests, which account for the correlation between paired observations, offer greater power than unpaired tests. Chi-square tests (χ² tests) were employed to evaluate hypotheses where the sampling distribution of the test statistic follows a chi-squared distribution under the null hypothesis; Pearson's chi-squared test is often referred to simply as the chi-squared test. For comparisons of unpaired proportions, either the chi-square test or Fisher’s exact test was used, depending on the context. To perform t-tests, the relevant formulae for test statistics, which either exactly follow or closely approximate a t-distribution under the null hypothesis, were applied, with specific degrees of freedom indicated for each test. P-values were determined from Student's t-distribution tables. A p-value ≤ 0.05 was considered statistically significant, leading to the rejection of the null hypothesis in favor of the alternative hypothesis.

Table 1: Distribution of Complications observed among Cases

Table2: Distribution of Symptom Profile among Study Group

In our study, 6 (10.0%) patients had Accelerated Hypertension, 1 (1.7%) patient had Bradycardia, 3 (5.0%) patients had Bradycardia With Hypotension, 2 (3.3%) patients had Cardiogenic Shock, 2 (3.3%) patients had Heart Block, 7 (11.7%) patients had Hypotension 6 (10.0%) patients had Pulmonary Edema, 3 (5.0%) patients had Pulmonary Edema With VT and 5 (8.3%) patients had VT complications.The value of z is 5.318. The value of p is < .00001. The result is significant at p < .05.In our study, 52 (86.7%) patients had Chest Pain, 26 (43.3%) patients had Dyspnoea, 15 (25.0%) patients had Syncope and 13 (21.7%) patients had Palpitation SymptomsThe value of z is 6.0726. The value of p is < .00001. The result is significant at p < .05.In Case, 45 (75.0%) patients had Normal Sr. potassium (3.5-5.4) and 15 (25.0%) patients had Hypokalaemia (<3.5).In Controls, 55 (91.66%) patients had Normal Sr. potassium (3.5-5.4) and 5 (8.33%) patients had Hypokalaemia (<3.5).Association of serum potassium levels (mEq/l) with Group was statistically significant (p=0.0143).

When there is myocardial cell necrosis brought on by severe and prolonged ischemia, an acute myocardial infarction takes place. MI is caused by obstructive mechanisms or coronary heart disease, which is defined as a blockage of blood flow caused by plaques in the coronary arteries. Patients with an acute MI frequently have electrolyte imbalances. In MI patients, electrolytes have a significant impact on how their prognosis changes. Regarding the predictive importance of serum electrolytes in individuals with acute MI, very little data is known. Thus, the relationship between blood potassium and sodium levels and the severity and prognosis of acute myocardial infarction (AMI) was the primary focus of this investigation. A total of 120 participants were enrolled in my study, and they were split evenly into study and control groups. The majority of cases fall into the 51–60 age range, which is consistent with research by Suresh Harsoor et al. [5] that found that similar age ranges for the maximum cases were 51–70 and 51–60 years, respectively.  In my analysis, cases revealed a small male predominance of 58.3% males and 41.7% females. My research and that of Madole M. B. et al. [6], who found that 46% of cases were female and 54% of cases were male, corresponded in this regard. In my study, chest pain accounted for 86.7% of the most common symptoms among MI cases, with dyspnea (43.3%), syncope (25.0%), and palpitations (21.7%) following closely behind. Chest discomfort (69%) was the most common presentation of AMI, according to the Vaidya CV et al [7], which closely matched my findings. 30% of the cases in my study, had hypernatremia, whereas 43% of the case group had it, according to Mati et al. [8]. While 45% of individuals with acute myocardial infarction had hypernatremia, according to Flear et al. [9]As previously indicated, in my study, the mortality rate was 22.2% (4/18) and 30% of patients in the cases group exhibited hypernatremia. My findings agree with a research conducted by Goldberg et al. 125). In a long-term follow-up, they discovered that hypernatremia at the time of admission or during the first 72 hours of hospitalization in STEMI were independently linked to a higher risk of 30-day mortality as well as a higher incidence of heart failure and death. Hypernatremia was also found to be frequently linked to higher rates of morbidity and death in MI patients; in a research by Suresh Harsoor et al. [5], 15% of patients with AMI who had hypernatremia ultimately died. In my study, 25% of cases had hypokalemic conditions. My results were consistent with the research conducted by Mati et al. [8], who found that 36% of the case group had hypokalemia.  Numerous research works have examined the relationship between hypokalemia and AMI patient death. According to a study by Goyal et al. [10], individuals with normal potassium levels had the lowest hospital mortality among MI patients. Additionally, the study demonstrated that patients with profound admission hypokalemia (potassium <3.0 mEq/L) were more likely to die in the hospital. In my research, 20% (3/15) of hypokalemic patients died; in investigations by Patilet al. [11], death was found in 21% and 24.5% of cases, respectively.

We conclude that, this study highlights a male predominance in acute myocardial infarction (MI) cases, suggesting a higher risk in males. Chest pain was the most common presenting symptom, followed by dyspnea, syncope, and palpitations, consistent with typical MI presentations. A notable finding was the high prevalence of electrolyte imbalances, particularly hyponatremia and hypokalemia, which were associated with increased morbidity and mortality. Patients with normal sodium and potassium levels showed better recovery outcomes, underscoring the importance of monitoring and promptly correcting electrolyte disturbances in MI patients. These results advocate for further research into the mechanisms linking electrolyte imbalances to MI outcomes to refine treatment protocols and potentially inform targeted interventions focused on electrolyte management in acute MI cases.

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