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Many epidemiological and clinical analysis have reported the relation between Mg and cardiovascular disease. Hypomagnesemia may be triggering mechanisms for ischemic heart disease, arrhythmias after open heart surgery, serious arrhythmias such as Torsades de Pointes (TdP) , and the negative feed back in congestive heart failure. Supplemental and therapeutic Mg infusion have been reported to reduce the mortality in acute myocardial infarction and having the cardioprotective effect after infarction (controversial) . It is also reported to reduce the incidence of arrhythmias after heart surgery, terminate the serious arrhythmias such as TdP, and improve the negative feed back in congestive heart failure. Magnesium metabolisms in cardiovascular disease are not necessarily clear. We expect the precise analysis of Mg actions and attractive Mg therapy in clinical literature.

Background: The present study was conducted to determine the relationship between magnesium concentration in cerebrospinal fluid (CSF) and delayed cerebral ischemia (DCI) in patients with subarachnoid hemorrhage (SAH)., Methods: We studied 39 consecutive patients undergoing surgery after SAH. A spinal drainage catheter was inserted into the lower lumbar vertebrae before surgery. CSF was then sampled and the magnesium concentration measured. General clinical data, Hunt-Hess (H-H) grade and Fisher grade, aneurysm size and site, intracerebral and intraventricular hemorrhage, and blood glucose levels were all recorded on admission. At the same time, the Glasgow coma scale (GCS) score was calculated. Outcomes were assessed using the Glasgow outcome scale at discharge. DCI was defined as a two-point decrease in the GCS score and/or focal deficit, and was confirmed by cerebral angiography. The recorded values were expressed as the median (interquartile range)., Results: Of the 39 patients, 23 (59%) had DCI. The magnesium concentration in the DCI cases was 2.8 (2.7 and 2.9) mg x dl(-1), which was significantly lower than that in the non-DCI cases, i. e., 2.9 (2.8 and 3.0) mg x dl(-1) (P < 0.05). There were no significant differences in the other factors., Conclusions: The results indicate that preoperative hypomagnesemia within the CSF might play a role in the development of DCI in patients with SAH; however, further studies will be necessary to confirm this observation.

A 57-year-old man was admitted to our hospital because of dyspnea due to congestive heart failure caused by hypertensive heart disease in September, 1992. Twenty years ago, he was diagnosed to be hypertensive, and in 1980, he was diagnosed to at our hospital to have primary aldosteronism (PA) due to a right aldosterone-producing adrenocortical adenoma (APA). There were no hypertensive vascular complications at that time. He refused surgical removal, and anti-hypertensive drugs including spironolactone were administered. However, his drug compliance was very inaccurate. On this recent admission, left ventricular hypertrophy associated with impaired contractivity, hypertensive retinal change and mild protein uria were noted, but no hematuria was detected. His renal function was impaired (Ccr: 15.2ml/min). An abdominal CT scan showed a typical right APA, bilateral renal atrophy and fine granular calcification at renal medulla, even though he had no hypercalcemia and hypercalciuria. In addition, multiple cerebral infarction was demonstrated by a brain CT scan, along with coronary artery stenoses at the right coronary artery and left circumflex branch by coronary angiography and bilateral multiple renal artery stenoses by renal angiography. Right adrenalectomy and renal biopsy were performed. Histological examinations revealed a yellow tan-colored APA, many sclerotic glomerulus, and severely hyarinized renal arterioles. After adrenalectomy, blood pressure was not normalized but was controlled easily by hypotensive agents. Impaired renal function was not improved and deteriorated slightly but did not get worse there after. Since 1959, including ours, 22 cases of APAs complicated with chronic renal failure were reported in Japan. In conclusion, surgical removal should be recommended for APA, even if the patient's condition is complicated with chronic renal failure.