Elsevier

American Heart Journal

Volume 132, Issue 3, September 1996, Pages 664-671
American Heart Journal

Curriculum in cardiology
Significance of magnesium in congestive heart failure

https://doi.org/10.1016/S0002-8703(96)90253-7Get rights and content

Abstract

Electrolyte balance has been regarded as a factor important to cardiovascular stability, particularly in congestive heart failure. Among the common electrolytes, te significance of magnesium has been debated because of difficulty inaccurate measurement and other associated factors, including other electrolyte abnormalities. The serum magnesium level represents <1% of total body stores and does not reflect total-body magnesium concentration, a clinical situation very similar to that of serum potassium. Magnesium is important as a cofactor in several enzymatic reactions contributing to stable cardiovascular hemodynamics and electrophysiologic functioning. Its deficiency is common and can be associated with risk factors and complications of heart failure. Typical therapy for heart failure (digoxin, diuretic agents, and ACE inhibitors) are influenced by or associated with significant alteration in magnesium balance. Magnesium therapy, both for deficiency replacement and in higher pharmacologic doses, has been beneficial in improving hemodynamics and in treating arrhythmias. Magnesium toxicity rarely occurs except in patients with renal dysfunction. In conclusion, the intricate role of magnesium on a biochemical and cellular level in cardiac cells is crucial in maintaining stable cardiovascular hemodynamics and electrophysiologic function. In patients with congestive heart failure, the presence of adequate total-body magnesium stores serve as an important prognostic indicator because of an amelioration of arrhythmias, digitalis toxicity, and hemodynamic abnormalities.

References (103)

  • C DeCarli et al.

    Serum magnesium levels in sympotomatic atrial fibrillation and their relation to rhythm control by intravenous digoxin

    Am J Cardiol

    (1986)
  • SA Strickberger et al.

    Multifocal atrial tachycardia from electrolyte imbalance

    Am Heart J

    (1988)
  • KD Chadda et al.

    Hypomagnesemia and refractory cardiac arrhythmia in a nmondigitalized patient

    Am J Cardiol

    (1973)
  • LT Iseri et al.

    Magnesium deficiency and cardiac disorders

    Am J Med

    (1975)
  • SR Levine et al.

    Hypomagnesemia and ventricular tachycardia

    Chest

    (1982)
  • EJ Topol et al.

    Hypomagnesemic torsades de pointes

    Am J Cardiol

    (1983)
  • JW Hollifield

    Potassium and magnesium abnormalities: diuretics and arrhythmias in hypertension

    Am J Med

    (1984)
  • JW Hollifield

    Thiazide treatment of hypertension

    Am J Med

    (1986)
  • H Tsuji et al.

    The associations of levels of serum potassium and magnesium with ventricular premature complexes (the Franingham heart study)

    Am J Cardiol

    (1994)
  • B Surawicz

    Is hypomagnesemia or magnesium deficiency arrhythmogenic?

    J Amm Coll Cardiol

    (1989)
  • RH Seller et al.

    Digitalis toxicity and hypomagnesemia

    Am Heart J

    (1970)
  • R Whang

    Magnesium deficiency: pathogenesis, prevalence and clinical implications

    Am J Med

    (1987)
  • RM McLean

    Magnesium and its therapeutic uses: a review

    Am J Med

    (1994)
  • C Vigorito et al.

    Hemodynamic effects of magnesium sulfate on the normal human heart

    Am J Cardiol

    (1991)
  • CD Enselberg et al.

    The effects of magnesium upon cardiac arrhythmias

    Am Heart J

    (1950)
  • RC Wesley et al.

    Effect of intravenous magnesium sulfate on supraventricular tachycardia

    Am J cardiol

    (1989)
  • WJ Fanning et al.

    Prophylaxis of atrial fibrillation with magnesium sulfate after coronary artery bypass grafting

    Ann Thorac Surg

    (1991)
  • MA Brodsky et al.

    Magnesium therapy in new onset atrial fibrillation: a randomized placebo-controlled double-blind study

    Am J Cardiol

    (1994)
  • JV Hays et al.

    Effect of magnesium sulfate on ventricular rate control in atrial fibrillation

    Ann Emerg Med

    (1994)
  • MF Ghani et al.

    The effectiveness of magnesiun chloride in the treatment of ventricular tachyarrhythmias due to digitalis intoxication

    Am Heart J

    (1974)
  • D Tzivoni et al.

    Magnesium therapy for torsades de pointes

    Am J Cardiol

    (1984)
  • BJ Allen et al.

    Magnesium sulfate therapy for sustained monomorphic ventricular tachycardia

    Am J Cardiol

    (1989)
  • DA Kirby et al.

    Inducible monomorphic sustained ventricular tachycardia in the conscious pig

    Am Heart J

    (1990)
  • Y Bashir et al.

    Effects of long-term oral magnesium chloride replacement in congestive heart failure secondary to coronary artery disease

    Am J Cardiol

    (1993)
  • SS Gottlieb et al.

    Effects of intravenous magnesium sulfate on arrhythmias in patients with congestivve heart failure

    Am Heart J

    (1993)
  • DM Roden et al.

    Effect of low potasium on magnesium concentration in isolated cardiac tissue

    Am J Med

    (1987)
  • R Whang et al.

    Magnesium deficiency and refractoriness to potassium depletion

    J Chron Dis

    (1977)
  • P Lim et al.

    Magnesium deficiency in patients on long-term diuretic therapy for heart failure

    Br Med J

    (1972)
  • S Kupfer et al.

    Effects of cardiac glycosides on renal tubular transport of calcium, magnesium, inorganic phosphate and glucose in the dog

    J Clin Invest

    (1965)
  • R Whang et al.

    Magnesium homeostasis and clinical disorders of magnesium deficiency

    Ann Pharmacother

    (1994)
  • OJ Riley et al.

    Renal adaptation to the failing heart

    Postgrad Med

    (1994)
  • R Whang et al.

    Frequency of hypomagnesemia and hypermagnesemia: requested vs routine

    JAMA

    (1990)
  • RS Elin

    Laboratory tests for the assessment of magnesium status in humans

    Magnesium Trace Elem

    (1991–1992)
  • E Ryzen et al.

    Magnesium deficiency in medical intensive care unit populations

    Crit Care Med

    (1985)
  • LT Iseri et al.

    Magnesium therapy of cardiac arrhythmias in critical care medicine

    Magnesium

    (1989)
  • R Whang et al.

    Predictors of clinical hypomagnesemia: hypokalemia, hypophosphatemia, hyponatremia and hypocalcemia

    Arch Intern Med

    (1984)
  • R Whang et al.

    Observations in experimental magnesium depletion

    J Clin Invest

    (1963)
  • MP Ryan et al.

    Effect of magnesium deficiency on cardiac and skeletal muscle potassium restriction

  • R Whang et al.

    The influence of continuing magnesium deficiency on muscle potassium repletion

    J Lab Clin Med

    (1979)
  • FW Heaton

    Distribution and function of magnesium within the cell

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