Arun Kaushik, P (2010) Correlation of Hyponatremia as an Independent Predictor of Short Term Mortality and Adverse Cardiac Events among Hospitalized Patients of Acute Stemi. Masters thesis, Coimbatore Medical College, Coimbatore.
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Abstract
Out of all 100 MI patients, 32 (32.0%) had hyponatremia in any of 3 days values. And 68 (68.0%) had completely normal sodium levels in all 3 days. Out of those 32 hyponatremics, 27 (84.4%) were males and 5 (15.6%) were females. And out of those 68, 55 (80.9%) were males and 13 (19.1%) were females. TYPES OF MI IN THE STUDY GROUP : Out of all MI patients 82 were males and 18 were females. Out of all MIs anteroseptal MI were around 24, AWMI 47, ALMI 5, IWMI 21, AND PWMI 3. Within the MI s male female ratio were studied. One patient had combined high lateral MI and ASMI. The patients who had hyponatremia were 32 and MIs were 33.in that AWMI were the highest in the male group (63 %) and AWMI & IWMI were the same in the female group ( 33.3%). SHORT TERM MORTALITY IN NORMO AND HYPONATREMICS : Among hyponatremics 75% were alive and among normonatremics 70% were alive. The short term mortality rate for hyponatremics and normonatremics were 25 % and 28 % respectively. TYPE OF MI WITH HYPONATREMICS AND ITS CORRELATION WITH DAY OF HYPONATREMIA : The territory of MIs were studied with days of hyponatremia. Certain patients had hyponatremia in all 3 or 2 days among 3 days of hyponatremia. The first day of hyponatremia is taken into account. In this regard, out of all 48 AWMIs, 19 had hyponatremia. This is divided within 3 days as 14, 1, 4 respectively. Out of all 4 ASMIs with hyponatremia, the distribution within days were 2, 1, 1 respectively Out of all 3 anterolateral MIs with hyponatremia, the distribution were 2, 0, 1 respectively Among 4 IWMIs with hyponatremia, the distribution were 3,0,1 respectively Among PWMIs with hyponatremia, the distribution were 1, 0, 1 respectivel Among 100 MIs, 32 had hyponatremia. Out of all 32 hyponatremia, 22 (68.8 %) had on the first day, 6.3 % on the second day, 8 % on the third day. PWMI had hyponatremia equally on first and the third day. DEGREE OF HYPONATREMIA WITH TERRITORY OF MI : The hyponatremia was classified into A (131 – 135) and B (125 – 130) to compare with the MI with severity. ASMI had the highest incidence (75%) of severe hyponatremia and ALMI had the least incidence (25%) of severe hyponatremia. AGE, HYPONATREMIA AND MORTALITY : Maximum cases of hyponatremia were in 41 – 50 yrs group in males and 51 – 70 yrs in females. Coming to mortality in hyponatremics among age groups 41 – 60 yrs which had the highest incidence of hypos among both sexes the mortality was 58.3 % and 100 % in less than 40 yrs group. DIABETES, HYPONATREMIA AND MORTALITY : Out of 100 patients studied 15 were diabetics. Out of which 12 were males and 3 were females. Out of 15 diabetics 5 were hyponatremic. Out of those 5, 4 were males and 1 was a female. Out of 5 hyponatremics among diabetics 3 were Alive and 2 died. CAHD HISTORY AND HYPONATREMIA, MORTALITY : Out of 100 in the study population 5 had old history of coronary heart disease. Out of those 4 were males and one was a female Out of 5 old CAD patients 2 developed hyponatremia. Out of which 1 was a male and the other a female Out of 5 old CAD patients 1 male developed hyponatremia and 1 female developed hyponatremia. The male hyponatremia persisted for all three days and the female hyponatremia persisted for only a single day. Out of 2 hyponatremics one was alive and the other was dead. THROBOLYSIS AND HYPONATREMIA, MORTALITY : Out of all MI patients 37 were thrombolysed based upon the inclusion and exclusion criteria. Out of those 37, 33 were males and 4 were females. Out of 37 who were thrombolysed 14 developed hyponatremia. out of those 148 were alive and 6 expired. LV DYSFUNCTION : LV Dysfuction is defined in our study as LVEF less than 50% as routine ECHO was done for all patients with MI Out of all 100 MIs patients, 35 patients had LVEF less than 50%. The male female ratio was 27 : 8 The incidence of hyponatremia was studied among those had LVEF less than 50%. Total hyponatremias were 17 where male female ratio was 13 : 4. Then the incidence of mortality was studied among those who had hyponatremia among low LVEF. Out of all 35 low LVEF, 17 had hyponatremia. Out of this 17, 11 (64.7 %) expired and 6 (35.3 %) are alive. ADVERSE CARDIAC EVENTS : Out of all MIs 22 patients developed adverse cardiac events such as arrhythmias, new onset failures during hospital stay. Out of those 22, 17 were males and 5 were females. Out of those 22 who developed adverse cardiac events 9 developed hyponatremia during hospital stay. The male female ratio was 2 : 1. HYPONATREMICS AMONG MORTALITY : Out of all MI s 72 were alive at 30 days follow up and 24 expired at 30 days follow up. Out of 72, 58 were male and 14 were females. Out of 28, 24 were males and 4 were females. Out of all 28 who expired within 30 days 11 developed hyponatremia during hospital stay. Out of those 11 (39%), 8 (72 %) were males and 3 (27%) were females. RHYTHM ABNORMALITIES : Incidence of hyponatremias in patients developed rhythm abnormalities were studied. Out of those rhythm abnormalities fascicular blocks were 7 where one had hyponatremia. In patients with AV blocks totally 6, 3 had hyponatremia. With patients with SVT/AF, no one had hyponatremia. From 5 patients with VT/VF, 4 had hyponatremia. CONCLUSION : 1. The short term mortality among patients who had hyponatremia who had LV dysfunction was higher when compared to patients who had normal sodium levels who had LV dysfunction. 2. The incidence of adverse cardiac events within first 72 hours was the same between patients who had hyponatremia and patients who had normal sodium levels among STEMI patients. 3. Short term mortality among MI patients who had hyponatremia increases as the age advances with highest incidence in the 61 – 70 yrs age group. 4. Assessment of serum sodium levels, thus must be carried out in all cases of acute STEMI so as to correct hyponatremia if present and there by preventing treatable complications and reducing mortality.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Hyponatremia ; Independent Predictor ; Short Term Mortality ; Adverse Cardiac Events ; Hospitalized Patients ; Acute Stemi. |
| Subjects: | MEDICAL > General Medicine |
| Depositing User: | Subramani R |
| Date Deposited: | 17 Feb 2018 18:58 |
| Last Modified: | 17 Feb 2018 18:58 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/5838 |
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