Hypomagnesemia and Its ECG Manifestations

Introduction

Magnesium is an essential electrolyte that plays a crucial role in numerous physiological processes, including cardiac function. Hypomagnesemia, or low serum magnesium levels (<1.7 mg/dL or <0.7 mmol/L), can have significant effects on the heart and may lead to dangerous arrhythmias. In this lecture, we will discuss the causes, symptoms, and ECG changes associated with hypomagnesemia.

Causes of Hypomagnesemia

Hypomagnesemia can result from various conditions, including: - Gastrointestinal losses (chronic diarrhea, malabsorption syndromes, excessive laxative use) - Renal losses (diuretic use, kidney disorders, uncontrolled diabetes) - Chronic alcoholism - Certain medications (e.g., proton pump inhibitors, aminoglycosides, cisplatin)

ECG Changes in Hypomagnesemia

Electrocardiographic manifestations of hypomagnesemia are often subtle but can increase the risk of arrhythmias. Common ECG findings include: - Prolonged QT interval, which can predispose patients to torsades de pointes, a life-threatening arrhythmia - Widened QRS complex (in severe cases) - ST depression and flattened T waves - Increased risk of atrial and ventricular arrhythmias

Clinical Implications

When hypomagnesemia is detected, especially in a patient with ECG abnormalities, it is crucial to correct it promptly. Treatment usually involves: - Oral magnesium supplementation for mild cases - Intravenous magnesium sulfate in severe cases or when arrhythmias are present

Conclusion

Hypomagnesemia can significantly affect cardiac function, and its impact is observable on ECG. Recognizing early signs and ensuring proper magnesium balance is essential for preventing complications such as life-threatening arrhythmias.

Source recommendations

1. American Heart Association Guidelines for Electrocardiography

  1. https://www.heart.org/en/health-topics/heart-attack/diagnosing-a-heart-attack/electrocardiogram-ecg-or-ekg
  2. https://www.ahajournals.org/doi/10.1161/circulationaha.108.191095
  3. https://cpr.heart.org/en/courses/acls-prep-ecg-pharmacology
  4. https://www.ahajournals.org/doi/10.1161/circulationaha.106.180200
  5. https://pubmed.ncbi.nlm.nih.gov/19281932/

2. European Society of Cardiology Guidelines on Arrhythmias

  1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Ventricular-Arrhythmias-and-the-Prevention-of-Sudden-Cardiac-Death
  2. https://academic.oup.com/eurheartj/article/43/40/3997/6675633
  3. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Supraventricular-Tachycardia
  4. https://pubmed.ncbi.nlm.nih.gov/36017572/
  5. https://www.ahajournals.org/doi/10.1161/01.cir.0000091380.04100.84

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