The Role of Hypomagnesemia in Cardiac Arrhythmias: A Clinical Perspective

Abstract

The importance of magnesium (Mg2+), a micronutrient implicated in maintaining and establishing a normal heart rhythm, is still controversial. It is known that magnesium is the cofactor of 600 and the activator of another 200 enzymatic reactions in the human organism. Hypomagnesemia can be linked to many factors, causing disturbances in energy metabolism, ion channel exchanges, action potential alteration and myocardial cell instability, all mostly leading to ventricular arrhythmia. This review article focuses on identifying evidence-based implications of Mg2+ in cardiac arrhythmias. The main identified benefits of magnesemia correction are linked to controlling ventricular response in atrial fibrillation, decreasing the recurrence of ventricular ectopies and stopping episodes of the particular form of ventricular arrhythmia called torsade de pointes. Magnesium has also been described to have beneficial effects on the incidence of polymorphic ventricular tachycardia and supraventricular tachycardia. The implication of hypomagnesemia in the genesis of atrial fibrillation is well established; however, even if magnesium supplementation for rhythm control, cardioversion facility or cardioversion success/recurrence of AF after cardiac surgery and rate control during AF showed some benefit, it remains controversial. Although small randomised clinical trials showed a reduction in mortality when magnesium was administered to patients with acute myocardial infarction, the large randomised clinical trials failed to show any benefit of the administration of intravenous magnesium over placebo.

Updated Mineral Composition and Potential Therapeutic Properties of Different Varieties of Olive Leaves from Olea europaea

“…Chronic hypocalcemia may be of multifactorial origin with osteoporosis being the most known issue and is usually prevented through a balanced diet and calcium supplements, sometimes associated with vitamin D and/or Mg supplementation [ 15 , 20 , 21 ]. A prosperous intake of proteins, Ca, and vitamin D demands higher levels of Mg, the same way that hypomagnesemia can lead to hypocalcemia and hypokalemia [ 22 , 23 , 24 , 25 , 26 ]. Malnourishment, obesity, and alcohol withdrawal might implicate deficiencies in inorganic phosphate (Pi) or adenosine triphosphate (ATP) related to bone health, myopathies, and central and peripheral nervous system and whose treatment calls for the proper regulation of phosphorus levels [ 27 , 28 , 29 , 30 , 31 , 32 , 33 ].…”

Postoperative Magnesium Sulfate Repletion Decreases Narcotic Use in Abdominal-Based Free Flap Breast Reconstruction

“…Besides its potential analgesic properties, magnesium's effect on the cardiovascular system is well established. 26 However, whether this effect extends to the microvasculature with a possible impact on microvascular procedures is not known. Furthermore, although we highlighted the significance of scheduling a close clinic follow-up within 1 week of discharge and utilizing visiting nurse services, we believe that the extended impact of ERAS in reducing narcotic use and minimizing the risk of prolonged usage warrants further investigation.…”

“…While statistical significance was not achieved in these outcomes, which can be attributed to factors such as our small sample size, heterogeneity in operative characteristics, and divergent dosing regimens, these trends indicate promising leads for further exploration. Besides its potential analgesic properties, magnesium's effect on the cardiovascular system is well established 26 . However, whether this effect extends to the microvasculature with a possible impact on microvascular procedures is not known.…”

Asymptomatic paroxysmal ventricular standstill in an elderly male following revascularization of multivessel coronary disease: A case report and literature review

“…Adrenergic stimulation of this pump during myocardial ischemia can deplete potassium levels and predispose patients to ventricular arrhythmias and SCD 6 . Magnesium regulates the activity of the renal outer medullary potassium (ROMK) channel and is inversely proportional to the open ROMK channel pores 7 . Hence, decreased intracellular magnesium levels cause more ROMK channels to open and lead to potassium wasting and the development of lethal arrhythmias 7 .…”