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Painless myocardial ischemia in chronic hemodialysed patients: a real event?
D Kremastinos1, I Paraskevaidis, S Voudiklari
1Cardiac Department, Athens General Hospital, Greece.
Insights
Silent myocardial ischemia, indicated by S-T segment deviation, occurred in 15.5% of hemodialysis patients. Hemodialysis itself appears to trigger these cardiac events, potentially due to changes in serum potassium and magnesium levels.
Area of Science:
- Nephrology
- Cardiology
- Electrophysiology
Background:
- Chronic renal failure (CRF) patients undergoing hemodialysis are at increased risk for cardiovascular complications.
- Silent myocardial ischemia, a significant predictor of adverse cardiac events, is often undiagnosed in this population.
- Holter electrocardiogram (ECG) monitoring is a valuable tool for detecting transient ischemic episodes.
Purpose of the Study:
- To investigate the incidence of painless (silent) myocardial ischemia in patients with CRF undergoing regular hemodialysis.
- To determine the timing and potential triggers of ischemic events during and outside of hemodialysis sessions.
- To explore the relationship between ECG findings and pre-existing cardiac dysfunction or coronary artery disease.
Main Methods:
- Forty-five patients with CRF on regular hemodialysis were enrolled.
- Continuous 48-hour Holter ECG monitoring was performed, encompassing dialysis and home activity periods.
- ECG analysis focused on S-T segment deviation and R,S,R + S amplitude changes.
Main Results:
- Silent myocardial ischemia (S-T segment deviation) was detected in 15.5% of patients.
- Ischemic events predominantly occurred during and immediately after hemodialysis sessions.
- A simultaneous increase in R,S,R + S amplitude was observed during these ischemic episodes.
- No correlation was found between S-T segment deviation and existing cardiac dysfunction or coronary artery disease.
Conclusions:
- Hemodialysis itself appears to be a significant factor in the genesis of silent myocardial ischemia in CRF patients.
- Serum electrolyte changes, specifically potassium (K) and magnesium (Mg) levels, may contribute to the observed ECG findings.
- Further research is warranted to elucidate the precise mechanisms linking hemodialysis, electrolyte shifts, and myocardial ischemia.
Abstract:
We investigated the incidence of painless (silent) myocardial ischemia, manifested as S-T segment deviation, by Holter ECG monitoring in patients with chronic renal failure undergoing regular hemodialysis. Forty-five patients underwent Holter ECG monitoring for a continuous 48-hour period covering dialysis and the intermediate period of everyday activity at home. ECG criteria for ischemia were found in 15.5% of patients mainly during and immediately after dialysis with a simultaneous increase of R,S,R + S amplitude. There was no correlation of S-T segment deviation with the existence of cardiac dysfunction and coronary artery disease proved by hemodynamic and angiographic studies. It is concluded that hemodialysis itself seems to play an important role in the genesis of the above ECG findings, possibly by means of serum K and Mg changes.