THE TAMILNADU DR. M.G.R MEDICAL UNIVERSITY CHENNAI –TAMILNADU DISSERTATION ON “ STUDY ON SERUM MAGNESIUM LEVELS IN ACUTE MYOCARDIAL INFARCTION ” SUBMITTED FOR MD DEGREE EXAMINATION BRANCH 1 (GENERAL MEDICINE ) EXAMINATION IN APRIL 2016 THANJAVUR MEDICAL COLLEGE THANJAVUR CERTIFICATE This is to certify that this dissertation entitled “ A STUDY ON SERUM MAGNESIUM LEVELS IN ACUTE MYOCARDIAL INFARCTION” is a bonafide record work done by Dr.ALEX BABY in the Department of General Medicine,Thanjavur Medical College,Thanjavur during his Post Graduate Course from 2013 – 2016.This is submitted as partial fulfillment for the requirement of M.D. Degree Examination, General Medicine (Branch 1) to be held in April 2016. Prof.Dr. K. NAGARAJAN Prof.Dr. K. NAMASIVAYAM Professor and HOD , Associate professor of Medicine, Department of Medicine, Department of Medicine, Thanjavur Medical college, Thanjavur Medical college, Thanjavur. Thanjavur. The DEAN Thanjavur Medical College, Thanjavur DECLARATION I, Dr. ALEX BABY, solemnly declare that dissertation titled “ A STUDY ON SERUM MAGNESIUM LEVELS IN ACUTE MYOCARDIAL INFARCTION ” is a bonafide work done by me at Thanjavur Medical College Hospital during July 2014 to May 2015 under the guidance and supervision of Prof.Dr.K.NAMASIVAYAM M.D.. The dissertation is submitted to THE TAMILNADU Dr. M.G.R. MEDICAL UNIVERSITY, CHENNAI, TAMILNADU as partial fulfillment for the requirement of M.D. Degree Examination – Branch 1 (General Medicine) to be held in April 2016. Place: Thanjavur Date: Dr. ALEX BABY ACKNOWLEDGEMENT I am extremely grateful to Dr.M. SINGARAVELU M.D., THE DEAN, Thanjavur Medical college for granting permission to do this dissertation work in Thanjavur Medical College Hospital, Thanjavur. I express my sincere gratitude to professor and HOD, Department of Medicine, Dr. K. NAGARAJAN, M.D., for his valuable support and guidance in preparing this dissertation. I express my deep sense of gratitude to my beloved professor Dr. K. NAMASIVAYAM M.D., Associate Professor of Medicine, Department of Medicine , My unit Chief, My Guide , who gave constant advice and care throughout study and without whose enthusiasm and support this study wouldnot have happened. I am thankful to my beloved Assistant professors, Dr. SEKAR M.D.,D.M., and Dr.KAVITHA M.D, of my unit for all guidance and help throughout the study. I thank Dr. R. SENTHILKUMAR M.D.,D.M., HOD, Department of Cardiology , for allowing me to study patients admitted to Intensive Coronary Care Unit of Thanjavur Medical College. I thank the Radiology and Biochemistry Departments for their help in Investigation aspects. I express my gratitude to all the patients who participated in this study. CONTENTS PAGE NO. 1. INTRODUCTION 1 2. AIM OF THE STUDY 3 3. REVIEW OF LITERATURE 4 4. MATERIALS AND METHODS. 52 5. RESULTS. 54 6. DISCUSSION. 70 7. CONCLUSION 74 8. SUMMARY 75 BIBLIOGRAPHY 76 PROFORMA 85 KEY TO MASTER CHART 97 MASTER CHART 98 LIST OF ABBREVIATIONS IHD ISCHEMIC HEART DISEASE TG TRIGLYCERIDES LPL LIPOPROTEIN LIPASE MAT MULTIFOCAL ATRIAL TACHYCARDIA VT VENTRICULAR TACHYCARDIA VF VENTRICULAR FIBRILLATION STEMI ST ELEVATION MI NSTEMI NON ST ELEVATION MI HDL HIGH DENSITY LIPOPROTEIN LDL LOW DENSITY LIPOPROTEIN Mg MAGNESIUM MGSO4 MAGNESIUM SULPHATE ATP ADENOSINE TRI PHOSPHATE VA VENTRICULAR ARRYTHMIAS NO NITRIC OXIDE MI MYOCARDIAL INFARCTION AV ATRIO VENTRICULAR SA SINO ATRIAL VLDL VERY LOW DENSITY LIPOPROTEIN ATN ACUTE TUBULAR NECROSIS CAD CORONARY ARTERY DISEASE CCF CONGESTIVE CARDIAC FAILURE DTR DEEP TENDON REFLEX GFR GLOMERULAR FILTERATION RATE PEM PROTEIN ENERGY MALNUTRITION.