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A STUDY of HYPONATREMIA AS a PROGNOSTIC INDICATOR in ACUTE MYOCARDIAL INFARCTION a Dissertation Submitted to the TAMILNADU DR. M

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A STUDY of HYPONATREMIA AS a PROGNOSTIC INDICATOR in ACUTE MYOCARDIAL INFARCTION a Dissertation Submitted to the TAMILNADU DR. M A STUDY OF HYPONATREMIA AS A PROGNOSTIC INDICATOR IN ACUTE MYOCARDIAL INFARCTION A Dissertation Submitted to THE TAMILNADU DR. M.G.R MEDICAL UNIVERSITY CHENNAI REGISTRATION NUMBER: 201711710 In Partial Fulfillment of the requirement for the Award of the Degree of M.D. (GENERAL MEDICINE) - BRANCH – I MAY 2020 1 CERTIFICATE FROM THE DEAN This is to certify that the dissertation entitled “A STUDY OF HYPONATREMIA AS A PROGNOSTIC INDICATOR IN ACUTE MYOCARDIAL INFARCTION” is the bonafide work of Dr. N.C. VIVEK ANAND in partial fulfilment of the University regulations of The Tamilnadu Dr. M.G.R Medical University, Chennai, for the award of degree of Doctor Of Medicine (M.D) Branch- I -General Medicine under my direct supervision and guidance , during the academic period of 2017 - 2020 Prof.Dr. R. BALAJI NATHAN M.D., Dean, Kanyakumari Government Medical College, Asaripallam.-629201 2 CERTIFICATE FROM THE HOD This is to certify that the dissertation entitled “A STUDY OF HYPONATREMIA AS A PROGNOSTIC INDICATOR IN ACUTE MYOCARDIAL INFARCTION” is the bonafide work of Dr. N.C.VIVEK ANAND in partial fulfilment of the University regulations of The Tamilnadu Dr. M.G.R Medical University, Chennai, for the award of degree of Doctor Of Medicine (M.D) Branch- I -General Medicine under my direct supervision and guidance , during the academic period 0f 2017 – 2020. Prof.Dr. PRINCE SREEKUMAR PIUS , M.D., HEAD OF DEPARTMENT, DEPT. OF MEDICINE, Kanyakumari Government Medical College, Asaripallam-629201. 3 CERTIFICATE FROM THE GUIDE This is to certify that the dissertation entitled “A STUDY OF HYPONATREMIA AS A PROGNOSTIC INDICATOR IN ACUTE MYOCARDIAL INFARCTION” is the bonafide work of Dr. N.C. VIVEK ANAND in partial fulfilment of the University regulations of The Tamilnadu Dr. M.G.R Medical University, Chennai, for the award of degree of Doctor Of Medicine (M.D) Branch- I -General Medicine under my direct supervision and guidance , during the academic period of 2017 – 2020. PROF.Dr. SANKAR, M.D., DEPT. OF MEDICINE, Kanyakumari Government Medical College, Asaripallam. 4 DECLARATION I, Dr. N.C. VIVEK ANAND, hereby declare that, I carried out this work entitled “A STUDY OF HYPONATREMIA AS A PROGNOSTIC INDICATOR IN ACUTE MYOCARDIAL INFARCTION” at Kanyakumari Government Medical College Hospital, Asaripallam, under the guidance of Professor .Dr. PRINCE SREEKUMAR PIUS M.D., Professor of Medicine, I also declare that this bonafide work has not been submitted in part or full by me or any others for any award, degree or diploma to any other University or Board either in India or abroad. This is submitted to The Tamilnadu Dr. M.G.R Medical University, Chennai, in partial fulfilment of the University rules and regulations for the award of degree of Doctor of Medicine (M.D) Branch- I-General Medicine. Place: Asaripallam Date: Dr. N.C. VIVEK ANAND 5 ACKNOWLEDGEMENTS I would like to express my sincere gratitude to Prof. Dr. R. BALAJI NATHAN, M.D., Dean, Kanyakumari Government Medical College, for having permitted me conduct this study and to use the hospital facilities at Kanyakumari Government Medical College Hospital, Asaripallam. I am greatly indebted to my beloved teacher Prof.Dr. PRINCE SREEKUMAR PIUS, M.D., Professor and Head, Department of Medicine for allowing me to do this study in the Department of Medicine. I also express my sincere thanks to him for giving me proper guidance, protocol and immense help and encouragement in conducting this study. I express my gratitude to Dr. SANKAR M.D., Assosciate professor, Department of Medicine who immensely helped me in conducting this study. I express my sincere and heartfelt gratitude to Dr. A. SRIVIDHYA., Dr. AMALAN CHRISTUDAS, Dr. JOHN VINOJ, Dr. BRINDA DAVIS, Dr. PREETHI SHAHILA Assistant professors in the Department of Medicine for their encouragement, kind guidance, constant support and cooperation in evaluating the patients. I thank the Members, Secretary and Chairman of the Institutional Ethical committee, Kanyakumari Government College hospital, Asaripallam. I thank all the paramedical staff and other staff of the Kanyakumari Government Medical College Hospital for all their help and cooperation in conducting this study. 6 I thank all my colleagues and friends for their constant encouragement and valuable criticism. I am extremely thankful to all my family members for their continuous support. Above all I thank God Almighty for his immense blessings. Last, but not least, my profound gratitude to all the patients, to whom I owe everything because this venture would not have been possible without them. 7 ETHICAL COMMITTEE APPROVAL 8 9 10 ANTI PLAGIARISM RECEIPT CERTIFICATE This is to certify that this dissertation work titled “ A STUDY OF HYPONATREMIA AS A PROGNOSTIC INDICATOR IN ACUTE MYOCARDIAL INFARCTION” of the candidate Dr. N.C.VIVEK ANAND with registration number 201711710 for the award of M.D in the branch of GENERAL MEDICINE. I personally verified the urkund .com website for the plagiarism check. I found that the uploaded thesis file contains from the introduction to conclusion pages and the result shows 2 percentage of plagiarism in the dissertation Guide & Supervisor sign with seal. 11 LIST OF ABBREVIATION ACS – Acute Coronary Syndrome LV – Left Ventricle ACE – Angiotensin Converting Enzyme MI – Myocardial infarction AMI- Acute Myocardial Infarction NSTEMI – Non ST Elevation MI ASMI – Anteroseptal Myocardial Infarction ODS –Osmotic Demyelination Syndrome ALMI – Anterolateral Myocardial Infarction PCI – Percutaneous Coronary Intervention ARF – Acute Renal Failure PTCA –Percutaneous transluminal AV –Atrio Ventricular coronary angiogram AWMI – Anterior Wall Myocardial Infarction RCA Right Coronary Artery ATP – Adenosine Tri Phosphate STEMI – ST Elevation MI AVP- Arginine Vasopressin SVC – Superior Vena Cava CAD- Coronary Artery Disease TIMI – Thrombolysis in MI CPK – Creatine Phosphokinase UA – Unstable Angina CK-MB – Creatinine Kinase-MB WHO – World Health Organisation CRP – C reactive protein CSW –Cerebral Salt Wasting CVA – Cerebro Vascular Accident DM – Diabetes Mellitus ECG- Electrocardiogram EF – Election Fraction GFR – Glomerular Filtration Rate HT – Hypertension LCA – Left Coronary Artery LBBB – Left Bundle Branch Block LVSD –Left Ventricular Systolic Dysfunction 12 CONTENTS S.No CONTENTS PAGE NO 1 INTRODUCTION 14 2 AIM OF THE STUDY 15 3 REVIEW OF LITERATURE 16 4 MATERIALS AND METHODS 69 5 STATISTICAL ANALYSIS 71 6 OBSERVATION AND RESULTS 72 7 DISCUSSION 86 8 CONCLUSION 93 9 BIBLIOGRAPHY 94 10 PROFORMA 99 11 MASTER CHART 113 12 ETHICAL COMMITTEE APPROVAL 8 13 ANTI PLAGIARISM RECEIPT 10 13 INTRODUCTION EPIDEMIOLOGY: Coronary artery disease is one of the most common cause of morbidity and mortality in both low income countries and developed countries. In the year 2012, globally27 cardiovascular diseases led to more than 17.5 million deaths. About 80% of these deaths occurred in low income/ middle income countries. According to WHO report in 2014,age adjusted cardiovascular disease mortality in India were 349 and 265 per 1,00,000 deaths in men and women respectively .The prevalence of CAD increased for past 30 years as per studies conducted in both rural and urban india1. NSSO Survey (National Statistical Survey Organisation) in its 16th survey (2004 to 2005) said that a total of 3,90,313 subjects evaluated .The prevalence of CAD ,found to be 7% in urban and 3% in rural population. Hyponatremia is one of the common electrolyte disorder11 . In case of heart failure it is the main predisposing factor for cardiovascular mortality. Hyponatremia most frequently found after MI,which is due to neurohumoral activation22 seen in acute STEMI &HF 14 AIMS OF THE STUDY 1. To study the effect of hyponatremia in acute myocardial infarction. 2. To study the association between severity of hyonatremia and ejection fraction, outcome in myocardial infarction. 3. To predict the importance of hyponatremia in acute Myocardial Infarction and assess the significance of hyponatremia as an independent factor in predicting short term mortality. 15 Review of literature ANATOMY OF HEART:5 . Location . Superior surface of diaphragm . Left of the midline . Anterior to the vertebral column, posterior to the sternum . COVERINGS OFHEART:5 Pericardium – a double-walled sac around the heart composed of: 1. A superficial fibrous pericardium 2. A deep two-layer serous pericardium a. The parietal layer lines the internal surface of the fibrous pericardium b. The visceral layer or epicardium lines the surface of the heart c. They are separated by the fluid-filled pericardial cavity . The Function of the Pericardium:5 1. Protects and anchors the heart 2. Prevents overfilling of the heart with blood 3. Allows for the heart to work in a relatively friction-free environment 16 ANTERIOR VIEW: 17 POSTERIOR VIEW: ATRIA OF THE HEART:5 . Atria are the receiving chambers of the heart, Right atrium receives from superior vena cava, inferior venae cava and coronary sinus whereas left atrium from pulmonary veins . Each atrium has a protruding auricle . Pectinate muscles mark atrial walls 18 VENTRICLES OF THE HEART: . Ventricles are the discharging chambers of the heart, Right ventricle pumps the blood into pulmonary artery , while left ventricle pumps into the aorta . Papillary muscles and trabeculae carneae muscles mark ventricular walls FRONTAL SECTION: 19 Superior border5 – Right atrium,left atrium and great vessels forms the superior border. Inferior border – Right and Left ventricles form the inferior border. Right border – is slightly convex andlong, formed by right atrium and ventricle above and below respectively, it is in line with SVC. Left border – major portion of left border is formed by left ventricle and smaller by left auricle. Ligamentum arteriosum- It extends from the origin of left pulmonary artery and aortic arch. Pulmonary artery: It divides into left and right branch inferior to aortic arch.Right branch passes below the arch.The branches are parallel and superior to the vein. Arch of aorta- gets arched into 2 planes,superiorly and to theleft, the pulmonary artery bifurcates below it.
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