ST elevation myocardial infarction magnesium therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

Magnesium administration is associated with vasodilation and some mild antiplatelet effects. Magnesium administation is useful in the managment of Torsades de pointes.

Magnesium Therapy

Randomized Trial Data

The safety and effectiveness of magnesium in the management of STEMI patients was evaluated in a series of 15 studies enrolling 68,684 patients between 1980 and 2002. The randomized data does not support the routine administration of magnesium to patients with ST elevation MI.

Indications

Magnesium can continue to be administered for repletion of documented electrolyte deficits and life-threatening ventricular arrhythmias such as torsade de pointes.

2004 ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction (DO NOT EDIT)

Class III (Harm)

"1. In the absence of documented electrolyte deficits or torsade de pointes type VT, routine intravenous magnesium should not be administered to STEMI patients at any level of risk. (Level of Evidence: A)"

Class IIa

"1. It is reasonable that documented magnesium deficits be corrected, especially in patients receiving diuretics before the onset of STEMI. (Level of Evidence: C)"

"2. It is reasonable that episodes of torsade de pointes type VT associated with a prolonged QT interval be treated with 1 to 2 grams of magnesium administered as an IV bolus over 5 minutes. (Level of Evidence: C)"

Sources

• The 2004 ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction

References

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