FREQUENCY OF HYPOKALEMIA AMONG PATIENTS PRESENTING WITH ACUTE MYOCARDIAL INFARCTION
Main Article Content
Keywords
Prevalence, Acute Myocardial Infarction, Hypokalemia, dysrhythmias
Abstract
Objectives: To find out the frequency of hypokalemia in patients presenting with acute myocardial infarction (AMI) at NICVD, Karachi, Pakistan.
Study design and setting
A descriptive Cross-Sectional Study was conducted at the Department of Cardiology during the period October 2, 2021, to April 1, 2022, at the National Institute of Cardiovascular Diseases, Karachi, Pakistan.
Materials and methods
The study comprised all patients who attended NICVD, Karachi, and met the inclusion criteria. Following an explanation of the process, risks, and advantages of the research, informed consent was obtained. Every individual had a fresh blood sample drawn, which was then sent to the lab for analysis. An auto-analyzer was used to measure the serum potassium levels to evaluate the outcome variable i.e., hypokalemia. All of the information gathered was electronically used for research purposes and recorded into the proforma that was provided at the conclusion.
Results: The mean ± SD of age was 49.18±8.85 years. In the distribution of gender, 73 (48.7%) were male while 77 (51.3%) were female. Hypokalemia was noted in 77 (51.3%) patients.
Conclusion: It is to be concluded that hypokalemia is highly prevalent in patients with acute myocardial infarction (AMI). Patients with AMI should be worked up for the presence of hypokalemia to ensure adequate treatment. To verify the present findings, more well-controlled, prospective studies are required.
References
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11. Shlomai G, Berkovitch A, Pinchevski-Kadir S, Bornstein G, Leibowitz A, Goldenberg I, et al. The association between normal-range admission potassium levels in Israeli patients with acute coronary syndrome and early and late outcomes. Medicine (Baltimore). 2016;95(23):e3778.
12. Colombo MG, Kirchberger I, Amann U, Heier M, Thilo C, Kuch B, et al. Admission serum potassium concentration and long-term mortality in patients with acute myocardial infarction: results from the MONICA/KORA myocardial infarction registry. BMC Cardiovasc Disord. 2017;17(1):198.
13. Kast DL. Prevalence of hypokalaemia in acute myocardial infarction patients. Int J Contem Med Surg Radiol. 2018;3(2):B41-3.
14. Skogestad J, Aronsen JM. Hypokalemia-induced arrhythmias and heart failure: new insights and implications for therapy. Front Physiol. 2018;9:1500.
15. Meghwal K. Study to evaluate the role of hypokalemia in acute myocardial infarction patients: a prospective hospital based study. Asian J Med Res.2019;8(2):1-3
16. Pitt B, Bakris G, Ruilope LM, DiCarlo L, Mukherjee R. Serum potassium and clinical outcomes in the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS). Circulation. 2008;118(16):1643–50.
17. Boguslavskyi A, Pavlovic D, Aughton K, Clark JE, Howie J, Fuller W, et al. Cardiac hypertrophy in mice expressing unphosphorylatable phospholemman. Cardiovasc Res. 2014;104(1):72-82.
18. Collins AJ, Pitt B, Reaven N, Funk S, McGaughey K, Wilson D, Bushinsky DA. Association of serum potassium with all-cause mortality in patients with and without heart failure, chronic kidney disease, and/or diabetes. Am J Nephrol. 2017;46(3):213-21.
19. Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2019;40(2):87-165.
20. Walker HK, Hall WD, Hurst JW, editors. Clinical methods: the history, physical, and laboratory examinations. 3rd edition. Boston: Butterworths; 1990.
21. Khan E, Spiers C, Khan M. The heart and K: a banana republic. Acute Card Care. 2013;15 (1):17-24.
22. Christenson E, Christenson RH. The role of cardiac biomarkers in the diagnosis and management of patients presenting with suspected acute coronary syndrome. Ann Lab Med. 2013;33(5):309-18.
23. Grodzinsky A, Goyal A, Gosch K, McCullough PA, Fonarow GC, Mebazaa A. Prevalence and prognosis of hyperkalemia in patients with AMI. Am J Med. 2016;129(8):858-65.
24. Goyal A, Spertus JA, Gosch K, Venkitachalam L, Jones PG, Van den Berghe G, et al. Serum potassium levels and mortality in acute myocardial infarction. JAMA. 2012;307(2):157- 64.
25. An JN, Lee JP, Jeon HJ, Kim DH, Oh YK, Kim YS, et al. Severe hyperkalemia requiring hospitalization: predictors of mortality. Crit Care. 2012;16(6):1-4.
26. McCullough PA, Beaver TM, Bennett-Guerrero E, Emmett M, Fonarow GC, Goyal A, et al. Acute and chronic cardiovascular effects of hyperkalemia: new insights into prevention and clinical management. Rev Cardiovasc Med. 2014;15(1):11-23.
27. Services USDoHaH. National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States. Centers for Disease Control and Prevention. 2014 [web page]. 2014
28. Weir MA, Juurlink DN, Gomes T, Mamdani M, Hackam DG, Jain AK, et al. Beta-blockers, trimethoprim-sulfamethoxazole, and the risk of hyperkalemia requiring hospitalization in the elderly: a nested case-control study. Clin J Am Soc Nephrol. 2010;5(9):1544-51.
29. Pitt B, Bakris G, Ruilope LM, DiCarlo L, Mukherjee R. Serum potassium and clinical outcomes in the Eplerenone Post–Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS). Circulation. 2008;118(16):1643-50.
30. Juurlink DN, Mamdani MM, Lee DS, Kopp A, Austin PC, Laupacis A, et al. Rates of hyperkalemia after publication of the randomized Aldactone evaluation study. N Engl J Med. 2004;351(6):543-51.
31. Wozakowska-Kapłon B, Janowska-Molenda I. Iatrogenic hyperkalemia as a serious problem in therapy of cardiovascular diseases in elderly patients. Pol Arch Med Wewn. 2009;119(3):141-7.
32. Perazella MA. Drug-induced hyperkalemia: old culprits and new offenders. Am J Med. 2000;109(4):307-14.
33. Fordjour KN, Walton T, Doran JJ. Management of hyperkalemia in hospitalized patients. Am J Med Sci. 2014;347(2):93-100.
34. McCullough PA, Soman SS. Contrast-induced nephropathy. Crit Care Clin. 2005;21(2): 261-80.
35. Garovic VD, Textor SC. Renovascular hypertension and ischemic nephropathy. Circulation. 2005;112(9):1362-74.
36. Choi JS, Kim YA, Kim HY, Oak CY, Kang YU, Kim CS, et al. Relation of serum potassium level to long-term outcomes in patients with acute myocardial infarction. Am J Cardiol 2014;113:1285–90.
37. Cohn JN, Kowey PR, Whelton PK, Prisant LM. New guidelines for potassium replacement in clinical practice: a contemporary review by the National Council on Potassium in Clinical Practice. Arch Intern Med. 2000;160(16):2429-36.
38. Xianghua F, Peng Q, Yanbo W, Shigiang L, Weize F, Yunfa J. The relationship between hypokalemia at the early stage of acute myocardial infarction and malignant ventricular arrhythmia. Heart. 2010;96:196.
39. Kast DL. Prevalence of hypokalaemia in acute myocardial infarction patients. Int J Contem Med Surg Radiol. 2018;3(2):B41-B43.
40. Shiyovich A, Gilutz H, Plakht Y. Serum potassium levels and long-term post-discharge mortality in acute myocardial infarction. Int J Cardiol 2014;172:e368–370.
41. Tada Y, Nakamura T, Funayama H, Sugawara Y, Ako J, Ishikawa SE, et al. Early development of hyponatremia implicates short-and long-term outcomes in ST-elevation acute myocardial infarction. Circulation J. 2011;75(8):1927-33.
42. Rogers WJ, Frederick PD, Stoehr E, Canto JG, Ornato JP, Gibson CM, et al. Trends in presenting characteristics and hospital mortality among patients with ST elevation and non-ST elevation myocardial infarction in the National Registry of Myocardial Infarction from 1990 to 2006. Am Heart J. 2008;156(6):1026-34.
43. Krogager ML, Eggers-Kaas L, Aasbjerg K, Mortensen RN, Kober L, Gislason G, et al. Short- term mortality risk of serum potassium levels in acute heart failure following myocardial infarction. Eur Heart J CVP 2015;1:245–51.
44. Macdonald JE, Struthers AD. What is the optimal serum potassium level in cardiovascular patients? J Am Coll Cardiol. 2004;43(2):155-61.
45. Iqbal R, Sami A, Ilyas M, Iftekhar MF, Ullah R, Arafat Y. Hypokalemia in patients with acute myocardial infarction. Pak Heart J. 2019;52(1).
46. Gerward S, Tyden P, Hansen O, Engstrom G, Janzon L, Hedblad B. Survival rate 28 days after with first myocardial infarction. Inverse relationship with socio-economic circumstances. J intern Med. 2009;154-72.
47. Masood A, Akhthar N. Review and guidelines for the management of patients with chronic therapeutically refractory angina. Pak J Cardiol. 2010;7:6-15.
48. Hasan W, Hameed S, Akbar AM, Kanwal A, Ishaq I Raza A. Comparison of in-hospital outcome of patients having first acute myocardial infarction with or without pre-infarct angina. J Cardiovasc Dis 2012;10(3):79.
2. Khan E, Spiers C, Khan M. The heart and K: a banana republic. Acute Card Care. 2013;15 (1):17-24.
3. Christenson E, Christenson RH. The role of cardiac biomarkers in the diagnosis and management of patients presenting with suspected acute coronary syndrome. Ann Lab Med. 2013;33(5):309-18.
4. Xianghua F, Peng Q, Yanbo W, Shigiang L, Weize F, Yunfa J. The relationship between hypokalemia at the early stage of acute myocardial infarction and malignant ventricular arrhythmia. Heart. 2010;96:196.
5. Choi JS, Kim YA, Kim HY, Oak CY, Kang YU, Kim CS, et al. Relation of serum potassium level to long-term outcomes in patients with acute myocardial infarction. Am J Cardiol 2014;113:1285–90.
6. Shiyovich A, Gilutz H, Plakht Y. Serum potassium levels and long-term post-discharge mortality in acute myocardial infarction. Int J Cardiol 2014;172:e368–70.
7. Kast DL. Prevalence of hypokalaemia in acute myocardial infarction patients. Int J Contem Med Surg Radiol. 2018;3(2):B41-3.
8. McCullough PA, Beaver TM, Bennett-Guerrero E, Emmett M, Fonarow GC, Goyal A, et al. Acute and chronic cardiovascular effects of hyperkalemia: new insights into prevention and clinical management. Rev Cardiovasc Med. 2014; 15(1):11–23.
9. Services USDoHaH. National Diabetes Statistics Report: estimates of diabetes and its burden in the United States. Centers for disease control and prevention. 2014
10. Grodzinsky A, Goyal A, Gosch K, McCullough PA, Fonarow GC, Mebazaa A, et al. Prevalence and prognosis of hyperkalemia in patients with acute myocardial infarction. Am J Med. 2016;129(8):858-65.
11. Shlomai G, Berkovitch A, Pinchevski-Kadir S, Bornstein G, Leibowitz A, Goldenberg I, et al. The association between normal-range admission potassium levels in Israeli patients with acute coronary syndrome and early and late outcomes. Medicine (Baltimore). 2016;95(23):e3778.
12. Colombo MG, Kirchberger I, Amann U, Heier M, Thilo C, Kuch B, et al. Admission serum potassium concentration and long-term mortality in patients with acute myocardial infarction: results from the MONICA/KORA myocardial infarction registry. BMC Cardiovasc Disord. 2017;17(1):198.
13. Kast DL. Prevalence of hypokalaemia in acute myocardial infarction patients. Int J Contem Med Surg Radiol. 2018;3(2):B41-3.
14. Skogestad J, Aronsen JM. Hypokalemia-induced arrhythmias and heart failure: new insights and implications for therapy. Front Physiol. 2018;9:1500.
15. Meghwal K. Study to evaluate the role of hypokalemia in acute myocardial infarction patients: a prospective hospital based study. Asian J Med Res.2019;8(2):1-3
16. Pitt B, Bakris G, Ruilope LM, DiCarlo L, Mukherjee R. Serum potassium and clinical outcomes in the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS). Circulation. 2008;118(16):1643–50.
17. Boguslavskyi A, Pavlovic D, Aughton K, Clark JE, Howie J, Fuller W, et al. Cardiac hypertrophy in mice expressing unphosphorylatable phospholemman. Cardiovasc Res. 2014;104(1):72-82.
18. Collins AJ, Pitt B, Reaven N, Funk S, McGaughey K, Wilson D, Bushinsky DA. Association of serum potassium with all-cause mortality in patients with and without heart failure, chronic kidney disease, and/or diabetes. Am J Nephrol. 2017;46(3):213-21.
19. Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2019;40(2):87-165.
20. Walker HK, Hall WD, Hurst JW, editors. Clinical methods: the history, physical, and laboratory examinations. 3rd edition. Boston: Butterworths; 1990.
21. Khan E, Spiers C, Khan M. The heart and K: a banana republic. Acute Card Care. 2013;15 (1):17-24.
22. Christenson E, Christenson RH. The role of cardiac biomarkers in the diagnosis and management of patients presenting with suspected acute coronary syndrome. Ann Lab Med. 2013;33(5):309-18.
23. Grodzinsky A, Goyal A, Gosch K, McCullough PA, Fonarow GC, Mebazaa A. Prevalence and prognosis of hyperkalemia in patients with AMI. Am J Med. 2016;129(8):858-65.
24. Goyal A, Spertus JA, Gosch K, Venkitachalam L, Jones PG, Van den Berghe G, et al. Serum potassium levels and mortality in acute myocardial infarction. JAMA. 2012;307(2):157- 64.
25. An JN, Lee JP, Jeon HJ, Kim DH, Oh YK, Kim YS, et al. Severe hyperkalemia requiring hospitalization: predictors of mortality. Crit Care. 2012;16(6):1-4.
26. McCullough PA, Beaver TM, Bennett-Guerrero E, Emmett M, Fonarow GC, Goyal A, et al. Acute and chronic cardiovascular effects of hyperkalemia: new insights into prevention and clinical management. Rev Cardiovasc Med. 2014;15(1):11-23.
27. Services USDoHaH. National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States. Centers for Disease Control and Prevention. 2014 [web page]. 2014
28. Weir MA, Juurlink DN, Gomes T, Mamdani M, Hackam DG, Jain AK, et al. Beta-blockers, trimethoprim-sulfamethoxazole, and the risk of hyperkalemia requiring hospitalization in the elderly: a nested case-control study. Clin J Am Soc Nephrol. 2010;5(9):1544-51.
29. Pitt B, Bakris G, Ruilope LM, DiCarlo L, Mukherjee R. Serum potassium and clinical outcomes in the Eplerenone Post–Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS). Circulation. 2008;118(16):1643-50.
30. Juurlink DN, Mamdani MM, Lee DS, Kopp A, Austin PC, Laupacis A, et al. Rates of hyperkalemia after publication of the randomized Aldactone evaluation study. N Engl J Med. 2004;351(6):543-51.
31. Wozakowska-Kapłon B, Janowska-Molenda I. Iatrogenic hyperkalemia as a serious problem in therapy of cardiovascular diseases in elderly patients. Pol Arch Med Wewn. 2009;119(3):141-7.
32. Perazella MA. Drug-induced hyperkalemia: old culprits and new offenders. Am J Med. 2000;109(4):307-14.
33. Fordjour KN, Walton T, Doran JJ. Management of hyperkalemia in hospitalized patients. Am J Med Sci. 2014;347(2):93-100.
34. McCullough PA, Soman SS. Contrast-induced nephropathy. Crit Care Clin. 2005;21(2): 261-80.
35. Garovic VD, Textor SC. Renovascular hypertension and ischemic nephropathy. Circulation. 2005;112(9):1362-74.
36. Choi JS, Kim YA, Kim HY, Oak CY, Kang YU, Kim CS, et al. Relation of serum potassium level to long-term outcomes in patients with acute myocardial infarction. Am J Cardiol 2014;113:1285–90.
37. Cohn JN, Kowey PR, Whelton PK, Prisant LM. New guidelines for potassium replacement in clinical practice: a contemporary review by the National Council on Potassium in Clinical Practice. Arch Intern Med. 2000;160(16):2429-36.
38. Xianghua F, Peng Q, Yanbo W, Shigiang L, Weize F, Yunfa J. The relationship between hypokalemia at the early stage of acute myocardial infarction and malignant ventricular arrhythmia. Heart. 2010;96:196.
39. Kast DL. Prevalence of hypokalaemia in acute myocardial infarction patients. Int J Contem Med Surg Radiol. 2018;3(2):B41-B43.
40. Shiyovich A, Gilutz H, Plakht Y. Serum potassium levels and long-term post-discharge mortality in acute myocardial infarction. Int J Cardiol 2014;172:e368–370.
41. Tada Y, Nakamura T, Funayama H, Sugawara Y, Ako J, Ishikawa SE, et al. Early development of hyponatremia implicates short-and long-term outcomes in ST-elevation acute myocardial infarction. Circulation J. 2011;75(8):1927-33.
42. Rogers WJ, Frederick PD, Stoehr E, Canto JG, Ornato JP, Gibson CM, et al. Trends in presenting characteristics and hospital mortality among patients with ST elevation and non-ST elevation myocardial infarction in the National Registry of Myocardial Infarction from 1990 to 2006. Am Heart J. 2008;156(6):1026-34.
43. Krogager ML, Eggers-Kaas L, Aasbjerg K, Mortensen RN, Kober L, Gislason G, et al. Short- term mortality risk of serum potassium levels in acute heart failure following myocardial infarction. Eur Heart J CVP 2015;1:245–51.
44. Macdonald JE, Struthers AD. What is the optimal serum potassium level in cardiovascular patients? J Am Coll Cardiol. 2004;43(2):155-61.
45. Iqbal R, Sami A, Ilyas M, Iftekhar MF, Ullah R, Arafat Y. Hypokalemia in patients with acute myocardial infarction. Pak Heart J. 2019;52(1).
46. Gerward S, Tyden P, Hansen O, Engstrom G, Janzon L, Hedblad B. Survival rate 28 days after with first myocardial infarction. Inverse relationship with socio-economic circumstances. J intern Med. 2009;154-72.
47. Masood A, Akhthar N. Review and guidelines for the management of patients with chronic therapeutically refractory angina. Pak J Cardiol. 2010;7:6-15.
48. Hasan W, Hameed S, Akbar AM, Kanwal A, Ishaq I Raza A. Comparison of in-hospital outcome of patients having first acute myocardial infarction with or without pre-infarct angina. J Cardiovasc Dis 2012;10(3):79.
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Apr 19, 2024
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Dr. Sartaj Uddin, Dr. Syed Danish Habib, Dr. Sahrish, Dr. Sadam Hussain, Dr. Shankar Lal, & Mohammad Ali Naper. (2024). FREQUENCY OF HYPOKALEMIA AMONG PATIENTS PRESENTING WITH ACUTE MYOCARDIAL INFARCTION. Journal of Population Therapeutics and Clinical Pharmacology, 31(4), 1323 – 1330. https://doi.org/10.53555/jptcp.v31i4.5767
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Author Biographies
Dr. Sartaj Uddin
National Institute of Cardiovascular Diseases, Karachi - Pakistan
Dr. Syed Danish Habib
National Institute of Cardiovascular Diseases, Karachi - Pakistan
Dr. Sahrish
National Institute of Cardiovascular Diseases, Karachi - Pakistan
Dr. Sadam Hussain
National Institute of Cardiovascular Diseases, Karachi - Pakistan
Dr. Shankar Lal
Department of Pediatrics, Children’s Hospital, Chandka Medical College, Shaheed Mohtarma Benazir Bhutto Medical University Larkana, Sindh - Pakistan.
Mohammad Ali Naper
Department of Surgery, Chandka Medical College at Shaheed Mohtarma Benazir Bhutto Medical University Larkana, Sindh - Pakistan