Indian Journal of Basic and Applied Medical Research; December 2013: Vol.-3, Issue-1 , 80-87 Original article : Effect of acute myocardial infarction on serum zinc level * DR. PRAVIN P. SHEKOKAR 1, DR. MRS. S. D. KAUNDINYA2 1Assistant Professor, Department of Physiology, Government Medical College, Akola, Collector Office Road, Akola. Pin 444001 (Maharashtra), India 2Professor & Head of Dept, Department of Physiology, Grant Government Medical College And Sir J.J. Hospital, Mumbai-8, India *Corrersponding author : Email: [email protected] Abstract: Introduction: Myocardial infarction is a common presentation of coronary artery disease. The diagnosis of acute myocardial infarction (AMI) is of vital importance from the management and prognosis point of view. Objective: The purpose of this study was to investigate serum zinc level in acute myocardial infarction patients and to correlate it with biochemical parameter SGOT. Methods: In the present study 30 patients suffering from acute myocardial infarction were taken as a study group with inclusion & exclusion criteria & were compared with the healthy control group. The serum zinc levels of both the groups were estimated on G.B.C.932 model atomic absorption spectrophotometer. The data were analyzed by student unpaired ttest. Results: The serum zinc level in acute myocardial infarction patients was significantly low as compared to healthy controls. In patients with AMI, there was good correlation between the serum zinc level and the biochemical marker of AMI like SGOT. Conclusion: A fall in plasma zinc is a reliable diagnostic test for acute myocardial infarction, and the extent of the fall has prognostic implications. Oral zinc administration to the patients of AMI may be helpful in the prognosis. Key words: Acute myocardial Infarction, Serum zinc INTRODUCTION Myocardial infarction results in death of Myocardial infarction is one of the dangerous myocardial cells. The acute inflammatory response manifestations of coronary artery disease and is one due to cell death, results in the liberation of of the commonest causes of mortality. It has now intracellular enzymes in the circulation several become an important health problem despite hours later. The intracellular enzymes routinely advancement in diagnosis and management over measured in the clinical laboratory for the purpose the Health of diagnosing and monitoring myocardial infarction organization estimated in 2004, that 12.2% of include creatine kinase (CK), aspartate amino worldwide deaths were from ischemic heart disease transferase (1) . The disease is often premature and severe, with dehydrogenase (LDH). These enzymes are present serious complications. Because of its frequency of in sufficiently high content in myocardial tissue so occurrence and potentially dreaded complications, that the death of a relatively small amount of tissue the diagnosis of acute myocardial infarction (AMI) results in a substantial increase in measured is of vital importance from management and the enzyme activity in serum (2). last few decades. The World (SGOT or AST), and lactate prognosis point of view. 80 www.ijbamr.com P ISSN: 2250-284X E ISSN :2250-2858 Indian Journal of Basic and Applied Medical Research; December 2013: Vol.-3, Issue-1 , 80-87 Zinc is one of the essential trace elements in man. a) History of prolonged and severe It is involved in nearly all aspects of cellular characteristic chest pain lasting more metabolism and is essential for cell division and than half an hour with associated DNA synthesis. Availability of zinc regulates the symptoms, rate of synthesis of nucleic acids and proteins b) suggesting that its availability may critically influence tissue reparative processes (3,4,5) Characteristic electrocardiographic abnormalities of acute MI on . standard 12 lead ECG like abnormal Estimation of serum zinc levels can be diagnostic 'Q' or 'QS' wave, ST segment of various diseases. Serum zinc levels have been elevation, T wave inversion, observed to fall after acute tissue injury irrespective c) Raised cardiac specific serum of its origin, including myocardial infarction, which enzymes like CPK-MB, CPK (T), produces some of the most striking falls. Levels of SGOT etc. zinc fall by 30 % within one or two days following d) Clinical examination of the patient, acute myocardial infarction. At the same time the Patients extent of the fall also correlated with the excluded from the study: complications of acute myocardial infarction. having a) following conditions were Patients having a previous history of Therefore it may serve as a yet another indicator in AMI or IHD or Diabetes mellitus assessing the prognosis following acute myocardial b) Patients with non-Q wave infarct, infarction (6,7,8) . The present study was undertaken c) ECG showing left ventricular to evaluate serum zinc levels in acute myocardial hypertrophy, bundle branch block, infarction patients and to correlate it with one of d) Patients with other medical illness the important biochemical parameters like SGOT like diabetes mellitus, hypertension, level (2) . alcoholic liver MATERIALS & METHODS disease, hepatitis, cerebro-vascular episode. In the present study, 60 subjects (both males and e) Patients on supplemental zinc females) were studied and they were divided in 2 Detailed history as per the proforma groups, Healthy Acute and clinical examination of every subject Myocardial infarction (30) group. The study was involved in the study was done including conducted at Sir J. J. Group of Hospitals, Mumbai electrocardiogram. Serum zinc level and SGOT during the year 2002-03. Thirty normal healthy were estimated in all the groups on the second staff personnel working in the basic sciences day of hospitalization to ICU. The individuals departments with no history of any medical illness were given an explanation about the relevance were included in this group as a control. Thirty of the study and the procedures. The Acute Myocardial infarction patients satisfying the participants gave informed written consent to inclusion criteria, irrespective of age and sex, participate in the experiment which was admitted at Medical Intensive Care Unit, Dept. of approved Medicine, Sir J. J. Hospital, Mumbai were committee of the institute. randomly selected for this study. Diagnosis of AMI Collection of blood sample was made using general guidelines based on WHO Taking usual aseptic precautions, 5 ml of fasting criteria for MI (9) Control (30) which includes: and by a human research ethics blood sample was collected from an antecubital 81 www.ijbamr.com P ISSN: 2250-284X E ISSN :2250-2858 Indian Journal of Basic and Applied Medical Research; December 2013: Vol.-3, Issue-1 , 80-87 vein into plastic test tubes taking care to prevent screw caps. The serum thus collected from all the the hemolysis and contamination. The sample was groups was subjected for estimation of serum zinc centrifuged at 3000 RPM for 15 minutes at (10) Hematology Laboratory, Dept. Of Physiology, measured by the colorimetric method. and SGOT (11) on the same day. SGOT were GMC, Mumbai. The supernatant serum (about 3 ml) was taken and delivered into plastic tubes with Preparation of sample for estimation of serum zinc level The serum prepared by above method was processed in the following way. 1) 1 ml serum + In Corning’s beaker 2) Sample + Add 5 ml of boil the sample till cons. Nitric acid (This step is repeated 3 times) Add 2 ml of Perchloric acid Evaporation boil the sample till Evaporation 3) Sample + Add 25 ml of dil. Nitric acid boil the sample to reduce (2 M HNO3) 4) Sample + volume for 10-15 minutes Add distilled water Sample ready for analysis by To make the volume 25 ml AAS In our study, the analysis was performed by G. B. Absorbance Vs Concentration is plotted. Concent- C. 932 model atomic absorption spectrophotometer rations of zinc in specimen samples were derived at B.A.R.C Institute of Science, Colaba, Mumbai from comparison of sample absorption with the and the instrument was used in accordance with the standard zinc curve. The results were expressed in manufacturers operating manual. The zinc level micrograms per 100 ml (mcg/dl). was determined by comparing the signal from Statistical analysis: After the data was obtained diluted serum with the signal from aqueous and tabulated it was subjected to statistical analysis standards. First the zinc standard solutions were using aspirated sequentially from most dilute to most significance of values obtained was found by concentrate. Then the diluted specimen serum determining 'p' value. The 'p' value obtained was in samples were aspirated into the atomic absorption comparison with the control group. The results flame and analyzed and their obtained on analysis were presented as Mean ± recorded. absorbance’s The resulting values were used to establish the working curve. student’s unpaired’ t’ test and the Standard Deviation for each of the parameters. A graph of 82 www.ijbamr.com P ISSN: 2250-284X E ISSN :2250-2858 Indian Journal of Basic and Applied Medical Research; December 2013: Vol.-3, Issue-1 , 80-87 RESULTS In the present study, total 60 subjects both male and female were studied. They were divided into the following groups. Table 1: Showing distribution of study group subjects and their serum zinc levels Serum zinc levels (In mcg/dl) Sr. Group No. No. 1. of Male Female Range Mean± S.D. Std. cases (n) Group A- Error 30 20 10 104 to 130 114.46 ± 7.632 1.39 30 19 11 55 - 120 81.1±16.09 2.93 Control 2. Group B – AMI Group A: Serum zinc was estimated in 30 Group B: Serum zinc was estimated in 30 acute apparently healthy volunteers consisting of 20 myocardial infarction patients consisting of 19 males and 10 females with an age range from 25 males and 11 females with an age range from 36 yrs to 48 yrs (mean age was 37.2 ± 12.4 yrs). It is yrs to 71 yrs. (Mean age was 54.16 yrs.) The serum evident from the above table that serum zinc level zinc level in AMI patients was ranging from 55 to in normal subjects was ranging from 104 to 130 120 mcg/dl with a mean value of 81.10 mcg/dl. mcg/dl with a mean value of 114.46 mcg/dl. Table 2: Showing mean and S.D. of serum zinc level in control and AMI group Sr. Serum zinc in No. control and AMI No. of Serum zinc levels (mcg/dl) cases Range Mean S. D. t p -8.99 0.000 group 1. Zinc in control 30 104 - 130 114.46 7.63 2. Zinc in AMI 30 55 - 120 81.1 16.09 *S *S - Significant The above table shows that serum zinc level in control and AMI group show statistically significant difference. 83 www.ijbamr.com P ISSN: 2250-284X E ISSN :2250-2858 Indian Journal of Basic and Applied Medical Research; December 2013: Vol.-3, Issue-1 , 80-87 Graph showing serum zinc level in control and AMI 130 120 110 Serum zinc level (mcg/dl) 100 90 80 70 60 50 40 30 20 10 0 Control AMI Shaded area indicates the mean value and line inside the shaded area shows range value Table 3: Showing mean and S.D. of SGOT and serum zinc level in AMI group Sr. SGOT/ Zinc No. level 1. SGOT in AMI 2. Zinc in AMI No. of cases Serum zinc levels (mcg/dl) Range Mean S. D. 30 18 - 189 64.33 35.24 30 55 - 120 81.10 16.09 t p -1.97 0.58 *N. S. * N. S. - Not significant The above table shows that serum zinc level and SGOT level in the AMI group do not show a statistically significant difference. Table 4: Showing the correlation between serum zinc level and SGOT level in AMI Mean SGOT level in Mean serum zinc Correlation AMI level in AMI coefficient 64.33 81.10 -0.585 Significance P = 0.001 *S *S - Significant The above table shows that there is an inverse correlation ship of serum zinc and SGOT in AMI group. 84 www.ijbamr.com P ISSN: 2250-284X E ISSN :2250-2858 Indian Journal of Basic and Applied Medical Research; December 2013: Vol.-3, Issue-1 , 80-87 DISCUSSION plasma zinc level as a nonspecific response to acute The present study was carried out to evaluate the stress. Flynn et al role of serum zinc in Acute myocardial infarction. adenohypophyseal - adrenocortical system which I. Serum zinc in control group: In this study, maintains the circulating zinc and mobilizes body serum zinc was estimated in 30 healthy individuals. zinc stores. It is possible that fall in zinc level after The serum zinc level in the control group was AMI may be steroid related. During stress, there is ranging from 104-130 mcg/dl (mean value of a release of a humoral factor produced by 114.46 mcg/dl). These values are comparable with polymorphs i.e. Leukocyte Endogenous Mediator studies done by various workers viz. Rosner et al (LEM) which depresses plasma zinc levels and (5) increases zinc uptake by the liver (8) , Halstead et al , Prasad et al (10) The average (16) supported the hypothesis of (17) . An increase serum zinc in our study in normal individuals was a in such a humoral agent after infarction might well little higher than reported by these authors. The explain the observed fall in serum zinc levels. difference in the values of normal serum zinc may Whatever the etiopathology, the fall in serum zinc be due to different geographical and environmental level in reliable and hence useful diagnostic index factors, dietary intake and different methods of in cases of AMI. estimation used. In our study, we also tried to correlate the II. Serum zinc in Acute Myocardial Infarction: extent of fall in serum zinc with that of SGOT level The serum zinc level in the control group was in AMI. The estimation of SGOT levels was ranging from 104 to 130 mcg/dl (mean value of carried out in AMI patients on the third day of 114.46 mcg/dl). Whereas the serum zinc in AMI acute infarction. The SGOT level was ranging from group was ranging from 55 to 120 mcg/dl (mean 18 to 189 IU/ml (mean value of 64.33 IU/ml). The value of 81.1 mcg/dl). We observed a statistically serum zinc level was ranging from 55 to 120 significant low serum zinc level estimated on the mcg/dl) mean value of 81.10 mcg/dl). This study rd 3 day of infarction in the AMI group as compared has found an inverse correlationship between the to normal healthy controls. rise in SGOT level and fall in serum zinc level but The same was observed by studies done by Wendy et al (12) , Mishra et al (2) , Halstead et al (13) , Surana et al (8) , Lindeman et al (14) . These workers it was not statistically significant. In contrast to our study, various studies done by Wendy et al Mishra et al (13) , Surana et al (14) (2) , have found a did serial estimation of zinc from the first day of statistically significant difference in the mean zinc acute myocardial infarction and they found out the level and the peak of SGOT level. They also significantly lowest serum zinc level in AMI after observed an inverse correlationship between the 48 hrs. of an acute attack and the level rises low level of serum zinc and the peak value of gradually as the patient recovers becoming normal SGOT level which is in accordance with our study. 2 weeks later. In the present study, serum zinc The difference in the observations of these studies estimation was therefore, done on the third day of may be due to time of estimation of serum zinc and AMI which was found to be low. SGOT level. In the previous studies, serial Bailey et al (15) suggested the mechanism estimation of serum zinc and SGOT level was for the fall in serum zinc level in AMI patients to carried out. Whereas, in the present study, the be an adrenal-cortical response to the stress of serum zinc and SGOT level were measured on the AMI. Halstead et al (8) suggested the fall in the third day of acute infarction. 85 www.ijbamr.com P ISSN: 2250-284X E ISSN :2250-2858 Indian Journal of Basic and Applied Medical Research; December 2013: Vol.-3, Issue-1 , 80-87 The data presented in this study indicate that a fall levels and fall in serum zinc level but it was in serum zinc is a useful diagnostic test for AMI. It not statistically significant. also suggests that anti-oxidant medication ACKNOWLEDGEMENT containing zinc may be beneficial in myocardial The authors wish to express their acknowledgement infarction and is highly recommended to improve to the Professor and HOD of Medicine and of patient outcome. The limitation of the present study Biochemistry, GMC, and Mumbai. The authors was that this could not find the correlation of the also acknowledge their gratitude to the laboratory extent of the fall with the complications of acute technical staff of Dept. of physiology, Grant Govt. myocardial infarction. Medical College, Mumbai for technical assistance CONCLUSION and patients admitted at an Intensive Care Unit, Sir 1. Normal serum zinc level was ranging from J.J. group of hospitals, Mumbai for showing their 104 to 130 mcg/dl (mean value of 114.46 willingness to take part in the study as subjects. mcg/dl). There was no change in the values This study was undertaken for dissertation purpose according to age and sex. to appear for MD (Physiology) examination of Serum zinc levels in acute myocardial Mumbai University. The author himself had borne infarction patients were ranging from 55 to the cost of estimation of serum zinc level. Hence 120 mcg/dl (mean value of 81.10 mcg/dl) there was no extra funding received for this study which was significantly lower as compared from any outside source. 2. to healthy control values. 3. This study has found an inverse correlationship between the rise in SGOT REFERENCES 1. World Health Organization (2008). The Global Burden of Disease: 2004 Update 2. Wendy, I. L., Hamid, I. : Plasma zinc in acute myocardial infarction. Diagnostic and Prognostic implications. Brit. Heart. J. 38 : 1339-1342, 1976 3. Bettiger, W. J., O'Dell, B. L. A. : Critical physiological role of the zinc in the structure and function of biomembranes. Life Science. 28: 1425-38, 1981. 4. Prasad, A. S. : Clinical spectrum and diagnostic aspects of human zinc deficiency. In : Prasad, A. S., Ed. Essential and toxic elements in human health and disease. New York : Alan R. Liss., 301-314, 1988. 5. Rosner, F. and Gorien, P. C. : Erythrocyte and plasma zinc and magnesium levels in health and disease. J. Lab. Clin. 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Date of submission: 25 Aug 2013 Date of Provisional acceptance: 15 September 2013 Date of Final acceptance: 20 October 2013 Date of Publication: 04 December 2013 Source of support: Nil; Conflict of Interest: Nil 87 www.ijbamr.com P ISSN: 2250-284X E ISSN :2250-2858
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