Changes in biochemical signs and electrolyte concentration in acute myocardial infarction

A. A. Ali; A. K. A. Hussein; R. M. Khalaf; A. A. Sahib

doi:10.15421/0225092

A. A. Ali University of Sumer
A. K. A. Hussein University of Sumer
R. M. Khalaf Mazaya University College
A. A. Sahib University of Sumer

Keywords: electrolytes, myocardial infarction, hyponatremia, hypokalemia, hypocalcemia, hypomagnesiumia, hypochloremia.

Abstract

Acute myocardial infarction (AMI) remains a leading cause of morbidity and mortality worldwide. Electrolyte imbalances, particularly alterations in sodium, potassium, calcium, magnesium, and chloride, play a significant role in cardiac electrophy siology and may influence the clinical course of AMI. To assess the prevalence and patterns of electrolyte disturbances in patients with AMI and to evaluate their association with comorbid hypertension and diabetes mellitus , a case–control study was co n ducted at the Heart Hospital in Nasiriyah, Southern Iraq, between October 2021 and March 2022. The study enrolled 100 partic i pants, including 51 patients with recent-onset AMI and 49 healthy controls. AMI diagnosis was confirmed according to ESC, ACC, AHA, and WHF guidelines. After an overnight fast, venous blood samples were collected and analyzed for serum sodium, potassium, chloride, calcium, and magnesium using a COBAS C411 analyzer, with verification by spectrophotometry. Among AMI patients (n = 51), hyponatremia was detected in 14 cases (27.5%), hypokalemia in 12 cases (23.5%), and hypocalcemia in 25 cases (49.0%). Electrolyte disturbances were more frequent among patients with hypertension (n = 46) and diabetes mellitus (n = 31) compared with those without these comorbidities. Potassium imbalance emerged as the most significant alteration, present in nearly two-thirds of the cases. Deficiencies in calcium and magnesium showed a strong association with sodium–potassium imbalance. Electrolyte disturbances, particularly hyponatremia and hypokalemia, are common in AMI and may co n tribute to adverse clinical outcomes. Early detection and correction of these abnormalities are essential for improving prognosis in AMI patients.

References

Adkins, G. B., & Curtis, M. J. (2015). Potential role of cardiac chloride channels and transporters as novel therapeutic targets. Pharmacology and Therapeutics, 145, 67–75.

Albus, C., & Haass, M. (2022). Main features of cardiac diseases. In: Herrmann-Lingen, C., Albus, C., & Titscher, G. (Eds.). Psychocardiology: A practical guide for doctors and psychologists. Springer, Berlin, Heidelberg.‏ Pp. 1–40.

Barbagallo, M., Dominguez, L. J., & Resnick, L. M. (2007). Magnesium metabolism in hypertension and type 2 diabetes mellitus. American Journal of Therapeutics, 14(4), 375–385.

Batta, Y., King, C., Johnson, J., Haddad, N., Boueri, M., & Haddad, G. (2022). Sequelae and comorbidities of COVID-19 manifestations on the cardiac and the vascular systems. Frontiers in Physiology, 12, 748972.

Belin, R. J., & He, K. (2007). Magnesium physiology and pathogenic mechanisms that contribute to the development of the metabolic syndrome. Magnesium Research, 20(2), 107–129.

Bueno-Orovio, A., Sánchez, C., Pueyo, E., & Rodriguez, B. (2014). Na/K pump regulation of cardiac repolarization: Insights from a systems biology approach. Pflugers Archiv: European Journal of Physiology, 466(2), 183–193.

Buja L. M. (2023). Pathobiology of myocardial ischemia and reperfusion injury: Models, modes, molecular mechanisms, modulation, and clinical applications. Cardiology in Review, 31(5), 252–264.

Carrizales-Sepúlveda, E. F., Vera-Pineda, R., Jiménez-Castillo, R. A., Violante-Cumpa, J. R., Flores-Ramírez, R., & Ordaz-Farías, A. (2021). The heart in diabetic ketoacidosis: A narrative review focusing on the acute cardiac effects and electrocardiographic abnormalities. The American Journal of the Medical Sciences, 361(6), 690–701.

Catalano, A., Basile, G., & Lasco, A. (2012). Hypocalcemia: A sometimes overlooked cause of heart failure in the elderly. Aging Clinical and Experimental Research, 24(4), 400–403.

Crintea, I. N., Cindrea, A. C., Mederle, O. A., Trebuian, C. I., & Timar, R. (2025). Electrolyte imbalances and metabolic emergencies in obesity: Mechanisms and clinical implications. Diseases, 13(3), 69.

Despa, S., & Bers, D. M. (2007). Functional analysis of Na+/K+-ATPase isoform distribution in rat ventricular myocytes. American Journal of Physiology. Cell Physiology, 293(1), C321–C327.

Despa, S., Lingrel, J. B., & Bers, D. M. (2012). Na+/K+-ATPase α2-isoform preferentially modulates Ca2+ transients and sarcoplasmic reticulum Ca2+ release in cardiac myocytes. Cardiovascular Research, 95(4), 480–486.

Dong, C., Yang, Y., Wang, Y., Hu, X., Wang, Q., Gao, F., Sun, S., Liu, Q., Li, L., Liu, J., Tang, Y., Zhang, S., Wu, C., & Zhu, H. (2023). Gut microbiota combined with metabolites reveals unique features of acute myocardial infarction patients different from stable coronary artery disease. Journal of Advanced Research, 46, 101–112.

El-Sherif, N., & Turitto, G. (2011). Electrolyte disorders and arrhythmogenesis. Cardiology Journal, 18(3), 233–245.

Faraj, H. R. (2015). Clinical study of some electrolytes (sodium, chloride and potassium) with patients in acute coronary syndrome (ACS). International Journal of Current Microbiology and Applied Sciences, 4(3), 700–705.

Feng, X. D., Wang, S. F., Qiao, S. Y., Huang, J. Y., Ma, Z. L., Zhou, D., Tang, J. Y., & Wei, Y. H. (2025). Correlational analysis of resistant hypertension with diabetes mellitus, chronic kidney disease, and the interplay of sodium, calcium, magnesium, and phosphorus. Vascular Health and Risk Management, 21, 217–228.

Gaw, A., Murphy, M. J., Srivastava, R., Cowan, R. A., & O’Reilly, D. S. J. (2013). Clinical biochemistry. 5th ed. Elsevier Health Sciences.

Goldberg, A., Hammerman, H., Petcherski, S., Zdorovyak, A., Yalonetsky, S., Kapeliovich, M., Agmon, Y., Markiewicz, W., & Aronson, D. (2004). Prognostic importance of hyponatremia in acute ST-elevation myocardial infarction. The American Journal of Medicine, 117(4), 242–248.

Haffner, S. M. (2000). Coronary heart disease in patients with diabetes. The New England Journal of Medicine, 342(14), 1040–1042.

Hao, J., Li, Y., Zhang, X., Pang, C., Wang, Y., Nigwekar, S. U., Qiu, L., & Chen, L. (2017). The prevalence and mortality of hyponatremia is seriously underestimated in Chinese general medical patients: An observational retrospective study. BMC Nephrology, 18(1), 328.

Hasona, N. A., & Elasbali, A. (2016). Evaluation of electrolytes imbalance and dyslipidemia in diabetic patients. Medical Sciences, 4(2), 7.

Heusch, G. (2020). Myocardial ischaemia-reperfusion injury and cardioprotection in perspective. Nature Reviews, Cardiology, 17(12), 773–789.

Huang, C. L., & Lei, M. (2023). Cardiomyocyte electrophysiology and its modulation: Current views and future prospects. Philosophical Transactions of the Royal Society of London, Series B, Biological Sciences, 378(1879), 20220160.

Kazory, A., & Ronco, C. (2020). Emergence of chloride as an overlooked cardiorenal connector in heart failure. Blood Purification, 49(1–2), 219–221.

Kitabchi, A. E., Umpierrez, G. E., Murphy, M. B., & Kreisberg, R. A. (2006). Hyperglycemic crises in adult patients with diabetes: A consensus statement from the American Diabetes Association. Diabetes Care, 29(12), 2739–2748.

Klemens, C. A., Chulkov, E. G., Wu, J., Hye Khan, M. A., Levchenko, V., Flister, M. J., Imig, J. D., Kriegel, A. J., Palygin, O., & Staruschenko, A. (2021). Loss of chloride channel 6 (CLC-6) affects vascular smooth muscle contractility and arterial stiffness via alterations to Golgi calcium stores. Hypertension, 77(2), 582–593.

Kucia, A. M., Beltrame, J. F., & Keenan, J. (2022). Chest pain assessment. In: Kucia, A. M., & Jones, I. D. (Eds.). Cardiac care: A practical guide for nurses. John Wiley & Sons. Pp. 216–230.

Liamis, G., Kalogirou, M., Saugos, V., & Elisaf, M. (2006). Therapeutic approach in patients with dysnatraemias. Nephrology, Dialysis, Transplantation, 21(6), 1564–1569.

Milionis, H. J., Liamis, G., & Elisaf, M. S. (2001). Appropriate treatment of hypernatraemia in diabetic hyperglycaemic hyperosmolar syndrome. Journal of Internal Medicine, 249(3), 273–276.

Näbauer, M., Beuckelmann, D. J., & Erdmann, E. (1993). Characteristics of transient outward current in human ventricular myocytes from patients with terminal heart failure. Circulation Research, 73(2), 386–394.

Nilsson, E., Gasparini, A., Ärnlöv, J., Xu, H., Henriksson, K. M., Coresh, J., Grams, M. E., & Carrero, J. J. (2017). Incidence and determinants of hyperkalemia and hypokalemia in a large healthcare system. International Journal of Cardiology, 245, 277–284.

Qirjazi, E., Salerno, F. R., Akbari, A., Hur, L., Penny, J., Scholl, T., & McIntyre, C. W. (2020). Tissue sodium concentrations in chronic kidney disease and dialysis patients by lower leg sodium-23 magnetic resonance imaging. Nephrology, Dialysis, Transplantation, 36(7), 1234–1243.‏

Rafaqat, S., Rafaqat, S., Khurshid, H., & Rafaqat, S. (2022). Electrolyte’s imbalance role in atrial fibrillation: Pharmacological management. International Journal of Arrhythmia, 23(1), 15.

Rasmussen, H. S. (1988). Justification for intravenous magnesium therapy in acute myocardial infarction. Magnesium Research, 1(1–2), 59–73.

Riphagen, I. J., Logtenberg, S. J., Groenier, K. H., van Hateren, K. J., Landman, G. W., Struck, J., Navis, G., Kootstra-Ros, J. E., Kema, I. P., Bilo, H. J., Kleefstra, N., & Bakker, S. J. (2015). Is the association of serum sodium with mortality in patients with type 2 diabetes explained by copeptin or NT-proBNP? (ZODIAC-46). Atherosclerosis, 242(1), 179–185.

Rosen, C. J. (2008). Primer on the metabolic bone diseases and disorders of mineral metabolism. 7th ed. ASBMR, Washington.

Saetang, M., Wasinwong, W., Oofuvong, M., Tanasansutthiporn, J., Rattanapittayaporn, L., Petsakul, S., Duangpakdee, P., Rodneam, P., Boonthum, P., Khunakanan, S., Churuangsuk, C., Sriwimol, W., Chantarokon, A., Nuanjun, K., & Yongsata, D. (2025). Effect of combined vitamin C and thiamine therapy on myocardial and inflammatory markers in cardiac surgery: A randomized controlled clinical trial. Nutrients, 17(6), 1006.

Salari, N., Morddarvanjoghi, F., Abdolmaleki, A., Rasoulpoor, S., Khaleghi, A. A., Hezarkhani, L. A., Shohaimi, S., & Mohammadi, M. (2023). The global prevalence of myocardial infarction: a systematic review and meta-analysis. BMC Cardiovascular Disorders, 23(1), 206.

Shahid, S. M., Rafique, R., & Mahboob, T. (2005). Electrolytes and sodium transport mechanism in diabetes mellitus. Pakistan Journal of Pharmaceutical Sciences, 18(2), 6–10.

Sher, A. A., Noble, P. J., Hinch, R., Gavaghan, D. J., & Noble, D. (2008). The role of the Na+/Ca2+ exchangers in Ca2+ dynamics in ventricular myocytes. Progress in Biophysics and Molecular Biology, 96(1–3), 377–398.

Solini, A., Zamboni, P., Passaro, A., Fellin, R., & Ferrannini, E. (2006). Acute vascular events and electrolytes variations in elderly patients. Hormone and Metabolic Research, 38(3), 197–202.

Solomon, R. J., & Cole, A. G. (1981). Importance of potassium in patients with acute myocardial infarction. Acta Medica Scandinavica, Supplementum, 647, 87–93.

Szerencsei, R. T., Kinjo, T. G., & Schnetkamp, P. P. (2013). The topology of the C-terminal sections of the NCX1 Na+/Ca2+ exchanger and the NCKX2 Na+/Ca2+-K+ exchanger. Channels, 7(2), 109–114.

Teymouri, N., Mesbah, S., Navabian, S. M. H., Shekouh, D., Najafabadi, M. M., Norouzkhani, N., Poudineh, M., Qadirifard, M. S., Mehrtabar, S., & Deravi, N. (2022). ECG frequency changes in potassium disorders: A narrative review. American Journal of Cardiovascular Disease, 12(3), 112–124.

Xianghua, F., Peng, Q., Yanbo, W., Yanbo, W., Shiqiang, L., Weize, F., & Yunfa, J. (2010). The relationship between hypokalaemia at the early stage of acute myocardial infarction and malignant ventricular arrhythmia. Heart, 96(S3), A196–A196.

Yadav, S., Yadav, J., Kumar, S., & Singh, P. (2024). Metabolism of macro-elements (calcium, magnesium, sodium, potassium, chloride and phosphorus) and associated disorders. In: Singh, R. L., Singh, P., & Pathak, N. (Eds.). Clinical applications of biomolecules in disease diagnosis: A comprehensive guide to biochemistry and metabolism. Springer Nature Singapore, Singapore. Pp. ‏177–203.