SILENT MYOCARDIAL ISCHEMIA IN HEMODIALYSIS PATIENTS - FACTOR FICTION?

Area of Science:

• Cardiology
• Nephrology
• Medical Monitoring

Background:

• Myocardial ischemia can manifest as ST segment changes on an electrocardiogram (ECG).
• Holter monitoring is a standard tool for detecting dynamic ECG abnormalities over extended periods.

Purpose of the Study:

• To investigate the incidence of myocardial ischemia, identified by ST segment changes, during and between hemodialysis sessions.
• To determine the role of hemodialysis in the development of these ECG changes.

Main Methods:

• Thirty-eight patients underwent 48-hour Holter ECG monitoring.
• Monitoring covered both the hemodialysis period and the intermediate period.
• ST segment changes were analyzed for incidence, duration, and severity.

Main Results:

• 17 patients (44.7%) experienced 165 episodes of dynamic ST segment changes, with durations up to 177 minutes and ST depression up to 4 mm.
• The affected patient group had a mean age of 45 ± 14 years, with 82.6% males, and common comorbidities including hypertension, diabetes mellitus, and coronary artery disease.
• Ventricular ectopics, including ventricular tachycardia, were observed in 35.3% of patients with ST changes. No significant hypotension or angina was reported during these episodes.

Conclusions:

• Hemodialysis is a significant factor in the occurrence of ST segment changes suggestive of myocardial ischemia.
• The study highlights the importance of cardiac monitoring in patients undergoing hemodialysis, even in the absence of typical ischemic symptoms.