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Disabling angina pectoris with normal coronary arteries in patients undergoing long-term hemodialysis
Insights
Patients on long-term hemodialysis can experience angina pectoris even with normal coronary arteries. This may be linked to anemia and hypertension, suggesting a potentially common, underdiagnosed condition.
Area of Science:
- Cardiology
- Nephrology
- Internal Medicine
Background:
- Long-term hemodialysis patients often present with angina pectoris, typically associated with severe coronary atherosclerosis.
- However, some patients on maintenance dialysis experience angina despite clear coronary arteries.
Purpose of the Study:
- To investigate the characteristics of patients undergoing long-term hemodialysis who present with angina pectoris despite normal coronary angiograms.
- To explore potential underlying mechanisms for angina in this specific patient group.
Main Methods:
- A retrospective study of nine patients undergoing regular maintenance dialysis for incapacitating angina.
- Coronary angiography was performed to assess coronary artery status.
- Patient characteristics including age, sex, hypertension severity, and left ventricular wall stress were analyzed.
Main Results:
- Four out of nine patients (44%) exhibited normal coronary angiograms.
- These patients with normal angiograms were predominantly female, significantly younger, and had more severe hypertension and higher left ventricular wall stress compared to those with coronary lesions.
- Anemia and increased myocardial oxygen demand secondary to hypertension were proposed as potential causes.
Conclusions:
- Angina pectoris in long-term hemodialysis patients can occur in the absence of significant coronary atherosclerosis.
- Younger female patients with severe hypertension and elevated left ventricular wall stress may be particularly susceptible.
- Further prospective studies are needed to determine the prevalence, but this association may be more common than previously thought.
Abstract:
Reports of patients undergoing long-term hemodialysis presenting with angina pectoris have usually shown severe coronary atherosclerosis. We studied a series of nine patients undergoing regular maintenance dialysis referred for incapacitating angina. Of them, four had strictly normal coronary angiograms. The patients with normal angiograms were all females who were significantly younger (p less than 0.05) and had more severe hypertension and higher left ventricular wall stress than patients showing coronary artery lesions. Anemia and increased myocardial oxygen consumption due to high blood pressure may explain the syndrome of angina pectoris in the presence of long-term dialysis in patients with normal coronary arteries. The prevalence of this association cannot be ascertained unless prospective studies are conducted. However, our data suggest that it might not be an uncommon finding.