The HYPONATREMIA IN ACUTE MYOCARDIAL INFARCTION AND SHORT-TERM CLINICAL OUTCOME: A CROSS-SECTIONAL STUDY

Authors

  • NAVEEN KUMAR G Institute of Internal Medicine, Madras Medical College, Chennai, Tamil Nadu, India
  • ANANDI C Department of General Medicine, Government Namakkal Medical College, Namakkal, Tamil Nadu, India. https://orcid.org/0009-0002-9559-8502
  • SEENIVASAN M Institute of Nephrology, Madras Medical College, Chennai, Tamil Nadu, India. https://orcid.org/0009-0005-8604-5959

DOI:

https://doi.org/10.22159/ajpcr.2025v18i3.53754

Keywords:

Acute myocardial infarction, Elderly, Hyponatremia, Left ventricular dysfunction

Abstract

Objectives: Neurohumoral activation in acute myocardial infarction (MI) causes hyponatremia and is associated with poor outcome. We aimed to establish a relationship between hyponatremia in acute ST-elevation MI (STEMI) and its complications.

Methods: Patients with acute STEMI were included. The patients were monitored for serum sodium at admission; at 24, 48, and 72 h; and echocardiographic evaluation at admission and at 72 h. Complications such as left ventricular (LV) failure and mortality during hospital stay were noted.

Results: In the acute setting of STEMI, hyponatremia was observed in 86% of patients aged >60 years (p=0.001). In patients with moderate LV dysfunction, 91% had hyponatremia at 24 h after admission, with persistent hyponatremia in 66.7% at 72 h (p=0.02). Within 24 h of admission, when the patient had normal serum sodium, the risk of complications was 16%, with mild hyponatremia the risk was 66.7%, with moderate hyponatremia the risk was 85.7%, and with severe hyponatremia the risk was 100% (p=0.001).

Conclusion: Elderly individuals are prone to hyponatremia following acute MI. LV dysfunction is associated with hyponatremia following MI. Moderate-to-severe hyponatremia is associated with a high risk of complications.

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References

Muthulakshmi R, Jamunarani R, Janani L, Sowmini K. A comparative study on efficacy and safety of streptokinase and reteplase in patients with myocardial infarction in a tertiary care teaching hospital. Asian J Pharm Clin Res. 2025;18(1):39-41. doi: 10.22159/ajpcr.2025v18i1.52907

Goyal A, Kahlon P, Jain D, Soni RK, Gulati R, Chhabra ST, et al. Trend in prevalence of coronary artery disease and risk factors over two decades in rural Punjab. Heart Asia. 2017;9(2):e010938. doi: 10.1136/ heartasia-2017-010938, PMID: 29469907

Nakao K. Hyponatremia and arginine vasopressin in early stage of ST-elevation acute myocardial infarction. -Surrogate markers or therapeutic targets? Circ J. 2011;75(8):1823-4. doi: 10.1253/circj.cj- 11-0649, PMID: 21737954

Graham LN, Smith PA, Stoker JB, Mackintosh AF, Mary DA. Time course of sympathetic neural hyperactivity after uncomplicated acute myocardial infarction. Circulation. 2003;107(7):793-7.

Spasovski G, Vanholder R, Allolio B, Annane D, Ball S, Bichet D, et al. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Nephrol Dial Transplant. 2014;29(2 Suppl 2):i1-39. doi: 10.1093/ndt/ gfu040, PMID: 24569496

Pradhan R, Tripathy D, Jali S. The correlation between serum sodium levels and the severity of cirrhosis of liver and its complications. Asian J Pharm Clin Res. 2024;17(6):38-40. doi: 10.22159/ajpcr.2024. v17i6.50762

Goldberg A, Hammerman H, Petcherski S, Nassar M, Zdorovyak A, Yalonetsky S, et al. Hyponatremia and long-term mortality in survivors of acute ST-elevation myocardial infarction. Arch Intern Med. 2006;166(7):781-6. doi: 10.1001/archinte.166.7.781, PMID: 16606816

Singla I, Zahid M, Good CB, Macioce A, Sonel AF. Effect of hyponatremia (<135mEq/L) on outcome in patients with non-ST-elevation acute coronary syndrome. Am J Cardiol. 2007;100(3):406-8. doi: 10.1016/j.amjcard.2007.03.039, PMID: 17659918

Mullens W, Verbrugge FH, Nijst P, Tang WH. Renal sodium avidity in heart failure: From pathophysiology to treatment strategies. Eur Heart J. 2017 Jun 21;38(24):1872-82. doi: 10.1093/eurheartj/ehx035, PMID: 28329085

Rouleau JL, de Champlain J, Klein M, Bichet D, Moyé L, Packer M, et al. Activation of neurohumoral systems in postinfarction left ventricular dysfunction. J Am Coll Cardiol. 1993;22(2):390-8. doi: 10.1016/0735- 1097(93)90042-y, PMID: 8101532

Filippatos TD, Makri A, Elisaf MS, Liamis G. Hyponatremia in the elderly: Challenges and solutions. Clin Interv Aging. 2017;12:1957-65. doi: 10.2147/CIA.S138535, PMID: 29180859

Bevilacqua M, Norbiato G, Chebat E, Raggi U, Cavaiani P, Guzzetti R, et al. Osmotic and nonosmotic control of vasopressin release in the elderly: Effect of metoclopramide. J Clin Endocrinol Metab. 1987;65(6):1243-7. doi: 10.1210/jcem-65-6-1243, PMID: 3680481

Lazzeri C, Valente S, Chiostri M, Attanà P, Picariello C, Gensini GF. Usefulness of hyponatremia in the acute phase of ST-elevation myocardial infarction as a marker of severity. Am J Cardiol. 2012;110(10):1419-24. doi: 10.1016/j.amjcard.2012.07.004, PMID: 22863175

Choi JS, Kim CS, Bae EH, Ma SK, Ahn YK, Jeong MH, et al. Prognostic impact of hyponatremia occurring at various time points during hospitalization on mortality in patients with acute myocardial infarction. Medicine (Baltimore). 2017;96(23):e7023. doi: 10.1097/ MD.0000000000007023, PMID: 28591032

Goldberg A, Hammerman H, Petcherski S, Zdorovyak A, Yalonetsky S, Kapeliovich M, et al. Prognostic importance of hyponatremia in acute ST-elevation myocardial infarction. Am J Med. 2004;117(4):242-8. doi: 10.1016/j.amjmed.2004.03.022, PMID: 15308433

Ma QQ, Fan XD, Li T, Hao YY, Ma F. Short- and long-term prognostic value of hyponatremia in patients with acute coronary syndrome: A systematic review and meta-analysis. PLoS One. 2018;13(3):e0193857. doi: 10.1371/journal.pone.0193857, PMID: 29499058

Yang XD, Zhao LY, Zheng QS, Li X. Effects of arginine vasopressin on growth of rat cardiac fibroblasts: Role of V1 receptor. J Cardiovasc Pharmacol. 2003;42(1):132-5. doi: 10.1097/00005344-200307000- 00020, PMID: 12827038

Naitoh M, Suzuki H, Murakami M, Matsumoto A, Arakawa K, Ichihara A, et al. Effects of oral AVP receptor antagonists OPC- 21268 and OPC-31260 on congestive heart failure in conscious dogs. Am J Physiol. 1994;267(6 Pt 2):H2245-54. doi: 10.1152/ ajpheart.1994.267.6.H2245, PMID: 7810724

Shattock MJ, Ottolia M, Bers DM, Blaustein MP, Boguslavskyi A, Bossuyt J, et al. Na+/Ca2+ exchange and Na+/K+-ATPase in the heart. J Physiol. 2015;593(6):1361-82. doi: 10.1113/jphysiol.2014.282319, PMID: 25772291

Wada K, Fujimori A, Matsukawa U, Arai Y, Sudoh K, Yatsu T, et al. Intravenous administration of conivaptan hydrochloride improves cardiac hemodynamics in rats with myocardial infarction-induced congestive heart failure. Eur J Pharmacol. 2005;507(1-3):145-51. doi: 10.1016/j.ejphar.2004.11.022, PMID: 15659304

Serradeil-Le Gal C, Wagnon J, Valette G, Garcia G, Pascal M, Maffrand JP, et al. Nonpeptide vasopressin receptor antagonists: Development of selective and orally active V1a, V2 and V1b receptor ligands. Prog Brain Res. 2002;139:197-210. doi: 10.1016/s0079- 6123(02)39017-4, PMID: 12436936

Schulze PC, Bogoviku J, Westphal J, Aftanski P, Haertel F, Grund S, et al. Effects of early empagliflozin initiation on diuresis and kidney function in patients with acute decompensated heart failure (EMPAG-HF). Circulation. 2022 Jul 26;146(4):289-98. doi: 10.1161/ CIRCULATIONAHA.122.059038, PMID: 35766022

Warren AM, Grossmann M, Christ-Crain M, Russell N. Syndrome of inappropriate antidiuresis: From pathophysiology to management. Endocr Rev. 2023;44(5):819-61. doi: 10.1210/endrev/bnad010, PMID: 36974717

Yeoh SE, Docherty KF, Jhund PS, Petrie MC, Inzucchi SE, Køber L, et al. Relationship of dapagliflozin with serum sodium: Findings from the DAPA-HF trial. JACC Heart Fail. 2022;10(5):306-18. doi: 10.1016/j.jchf.2022.01.019, PMID: 35483792

Published

07-03-2025

How to Cite

NAVEEN KUMAR G, et al. “The HYPONATREMIA IN ACUTE MYOCARDIAL INFARCTION AND SHORT-TERM CLINICAL OUTCOME: A CROSS-SECTIONAL STUDY”. Asian Journal of Pharmaceutical and Clinical Research, vol. 18, no. 3, Mar. 2025, pp. 16-19, doi:10.22159/ajpcr.2025v18i3.53754.

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