Skip to main content
SpringerLink
Log in

Stellenwert von K+ und Mg2+ bei der Behandlung des akuten Myokardinfarktes

The role of potassium and magnesium in the treatment of acute myocardial infarction

  • Published:
Herz Aims and scope Submit manuscript

Zusammenfassung

Eine kritische Durchsicht der wissenschaftlichen Literatur zeigt diskrepante und in bedeutsamem Umfang methodisch unzureichende Befunde zur Wirkung von Mg2+ bei akuten infarktbedingten Herzrhythmusstörungen und bei infarktbedingten Todesfällen. Nach derzeitiger Datenlage kann weder eine antiarrhythmische Wirkung von Magnesium noch eine prophylaktische Wirkung im Sinne einer Mortalitätsverminderung bei akutem Myokardinfarkt als zweifelsfrei gesichert gelten. Im Gegensatz hierzu sollte bei Patienten mit akutem Myokardinfarkt und dokumentierter Hypokaliämie (Kalium <3,5 mmol/l) eine Kaliumsubstitution erfolgen, um der Entwicklung ventrikulärer Arrhythmien entgegenzuwirken. Der therapeutische Einsatz von Magnesium bei akutem Myokardinfarkt kommt dagegen nur im Rahmen klinisch kontrollierter Studien in Betracht.

Summary

A critical analysis of literature concerning the effects of intravenous magnesium on arrhythmias and mortality in acute myocardial infarction shows discrepant results and often inappropiate methods. So far neither an antiarrhythmic efficacy nor prophylactic effects with respect to mortality could be demonstrated. In contrast, potassium substitution should be performed in the setting of acute myocardial infarction with documented hypokalemia (K+ <3.5 mmol/l) because of increased risk of ventricular arrhythmias. According to the documented results of the trials reviewed in this article no recommendations for the routine use of magnesium in myocardial infarction can be given.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Abraham, A. S., D. Rosenman, M. Kramer, J. Balkin, M. M. Zion, H. Farbstien, M. Eylath: Magnesium in the prevention of lethal arrhythmias in acute myocardial infarction. Arch. intern. Med. 147 (1987), 753–755.

    Article  PubMed  CAS  Google Scholar 

  2. Billman, G. E., R. S. Hoskins: Prevention of ventricular fibrillation with magnesium sulfate. Europ. J. Pharmacol. 158 (1988), 167–171.

    Article  CAS  Google Scholar 

  3. Bril, A., L. Rochette: Prevention of reperfusion induced ventricular arrhythmia in isolated rat heart with magnesium. Canad. J. Physiol. Pharmacol. 68 (1990), 694–699.

    CAS  Google Scholar 

  4. Brown, M. J.: Hypokalemia from beta-2-receptor stimulation by circulating epinephrine. Amer. J. Cardiol. 56 (1985), 3D-9D.

    Article  PubMed  CAS  Google Scholar 

  5. Ceremuzynski, L., R. Jurgiel, P. Kulakowski, J. Gebalska: Threatening arrhythmias in acute myocardial infarction are prevented by intravenous magnesium sulfate. Amer. Heart J. 118 (1989), 1333–1334.

    Article  PubMed  CAS  Google Scholar 

  6. Clark, B. B., J. R. Cummings: Arrhythmias following experimental coronary occlusion and their response to drugs. Ann. N. Y. Acad. Sci. 64 (1956), 43.

    Article  Google Scholar 

  7. Feldstedt, M., S. Boesgaard, P. Bouchelouche, A. Svenningsen, L. Brooks, Y. Lech, J. Aldershvile, K. Sagen, J. Godtfredsen: Magnesium substitution in acute ischemic heart syndromes. Europ. Heart J. 12 (1991), 1215–1218.

    CAS  Google Scholar 

  8. Harris, A. S., A. Bisteni, R. A. Russell, J. C. Brigham, J. E. Firestone: Excitatory factors in ventricular tachycardia resulting from myocardial ischemia. Science 119 (1954), 200–203.

    Article  PubMed  CAS  Google Scholar 

  9. Horner, S. M.: Efficacy of intravenous magnesium in acute myocardial infarction in reducing arrhythmias and mortality. Meta-analysis of magnesium in acute myocardial infarction. Circulation 86 (1992), 774–779.

    PubMed  CAS  Google Scholar 

  10. ISIS Collaborative Group: ISIS-4: a randomised study of intravenous magnesium in 58050 patients with suspected acute myocardial infarction. Lancet 345 (1995), 669–685.

    Article  Google Scholar 

  11. Kafka, H., L. Langren, P. W. Armstrong: Serum magnesium and potassium in acute myocardial infarction. Arch. intern. Med. 147 (1987), 465–469.

    Article  PubMed  CAS  Google Scholar 

  12. Krakau, I., U. Pöppelmann, H. Gülker: Magnesium, Herzrhythmusstörungen und akuter Myokardinfarkt. Springer, Berlin-Heidelberg-New York 1995.

    Google Scholar 

  13. Kunert, M., R. Sorgenicht, H. Stolzenburg, L. Scheuble, M. Horlitz, E. Lürken, K. Emmerich, I. Krakau, L. J. Ulbricht, H. Probst, H. Gülker: Safety of intravenous magnesium / potassium infusion therapy in patients with acute myocardial infarction undergoing primary PTCA. Proceedings of the 5th European Magnesium Congress. John Libbey (in press).

  14. Landmark, K., P. Urdal: Serum magnesium and potassium in acute myocardial infarction: relationship to existing beta-block-ade and infarct size. Angiology 44 (1993), 347–352.

    Article  PubMed  CAS  Google Scholar 

  15. Morton, B. C., R. C. Nair, F. M. Smith, R. G. McKibbon, W. J. Poznanski: Magnesium therapy in acute myocardial infarction — a double blind study. Magnesium 3 (1984), 346–352.

    PubMed  CAS  Google Scholar 

  16. Nattel, S., N. Turmel, R. Macleod, B. C. Solymoss: Actions of intravenous magnesium on ventricular arrhythmias caused by acute myocardial infarction. J. Pharmacol. exp. Ther. 259 (1991), 929–946.

    Google Scholar 

  17. Nordrehaug, J. E., K. A. Johanessen: Serum potassium concentration as a risk factor of ventricular arrhythmias early in acute myocardial infarction. Circulation 71 (1985), 645–649.

    PubMed  CAS  Google Scholar 

  18. Rasmussen, S. H., P. Norregard, D. Lindenag: Intravenous magnesium in acute myocardial infarction. Lancet 1 (1986), 234–236.

    PubMed  CAS  Google Scholar 

  19. Shechter, M., H. Hod, N. Marks, S. Behar, E. Kaplinsky, B. Rabinowitz: Beneficial effect of magnesium sulfate in acute myocardial infarction. Amer. J. Cardiol. 66 (1990), 271–274.

    Article  PubMed  CAS  Google Scholar 

  20. Shechter, M., H. Hod, P. Chouraqui, E. Kaplinsky, B. Rabinowitz: Magnesium therapy in acute myocardial infarction when patients are not candidates for thrombolytic therapy. Amer. J. Cardiol. 75 (1995), 321–323.

    Article  PubMed  CAS  Google Scholar 

  21. Smith, L. F., A. M. Heagerty, R. F. Bing, D. B. Barnett: Intravenous infusion of magnesium after acute myocardial infarction: effects on arrhythmias and mortality. Int. J. Cardiol. 12 (1986), 175–180.

    Article  PubMed  Google Scholar 

  22. Teo, K. K., S. Yusuf: Role of magnesium in reducing mortality in acute myocardial infarction. Drugs 46 (1993), 347–359.

    Article  PubMed  CAS  Google Scholar 

  23. Tzivoni, D., A. Keren, A. M. Cohen, H. Loebel, I. Zahavi, A. Chenzbraun, S. Stern: Magnesium therapy for torsade de pointes. Amer. J. Cardiol. 53 (1984), 528–530.

    Article  PubMed  CAS  Google Scholar 

  24. Woods, K. L., S. Fletcher, C. Roffe, Y. Haider: Intravenös verabreichtes Magnesium-Sulfat bei Verdacht auf akuten Myokardinfarkt: Ergebnisse des zweiten Leicester Intravenous Magnesium Trial (LIMIT 2). Lancet 339 (1992), 1553–1558.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Medizinische Klinik B (Kardiologie), Herzzentrum der Universität Witten/Herdecke, Heusnerstraße 40, D-42283, Wuppertal

    M. Kunert, L. Scheuble, H. Stolzenburg & H. Gülker

Authors
  1. M. Kunert
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L. Scheuble
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. H. Stolzenburg
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. H. Gülker
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kunert, M., Scheuble, L., Stolzenburg, H. et al. Stellenwert von K+ und Mg2+ bei der Behandlung des akuten Myokardinfarktes. Herz 22 (Suppl 1), 63–72 (1997). https://doi.org/10.1007/BF03042657

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03042657

Search

Navigation