[Pharmacotherapy of silent myocardial ischemia in patients on hemodialysis]
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J Gonsorcík1, M Szakács, S Palko
1IV. interná klinika FN L. Pasteura, Kosice.
Insights
Silent myocardial ischemia is common in dialysis patients, often occurring post-treatment. Three drugs—nitroglycerin, metoprolol, and verapamil—significantly reduced ischemia, with verapamil preferred for secondary hyperparathyroidism effects.
Area of Science:
- Nephrology
- Cardiology
- Pharmacology
Context:
- Cardiovascular complications are leading causes of mortality in patients undergoing regular dialysis.
- Accelerated atherosclerosis and extracardiac factors contribute to myocardial ischemia in this population.
- Silent myocardial ischemia affects 30-40% of long-term hemodialysis patients, typically appearing post-dialysis.
Purpose:
- To investigate the prevalence of silent myocardial ischemia in hemodialysis patients.
- To evaluate the efficacy of nitroglycerin, metoprolol, and verapamil in managing myocardial ischemia in dialysis patients.
- To explore management strategies for myocardial ischemia in patients on regular dialysis.
Summary:
- A study monitored 60 hemodialysis patients, finding silent myocardial ischemia in 30-40% via 24-hour Holter monitoring.
- Twenty patients with ST segment depressions received nitroglycerin, metoprolol, or verapamil, all showing significant reductions in ischemia intensity and duration.
- Verapamil is favored for its dual benefit in treating myocardial ischemia and addressing secondary hyperparathyroidism sequelae.
Impact:
- Pharmacological interventions can effectively manage myocardial ischemia in dialysis patients.
- Verapamil offers a potential therapeutic advantage by addressing both ischemia and secondary hyperparathyroidism.
- Further cardiac evaluation, including stress tests and coronarography, is crucial for refractory cases, guiding potential pre-transplant revascularization.
Abstract:
Cardiovascular complications are the main causes of morbidity and mortality of patients on regular dialysis treatment. Myocardial ischaemia in those patients may be promoted apart from accelerated atherosclerosis also by many extracoronary and extracardial factors. In a group of 60 haemodialyzed patients followed up on a long-term basis silent myocardial ischaemia is encountered during 24-hour Holter monitoring in 30-40% of the examined patients. Its occurrence at the end of haemodialysis and during the early posthemodialytic period and its long persistence are typical. The authors examined 20 regularly dialyzed patients with transient depressions of the ST segment in whom they tested retarded nitroglycerin, metoprolol and verapamil. All three drugs had a significant effect on the myocardial ischaemia (intensity and duration of depressions of the ST segment). In addition to correction of the modifying factors of silent myocardial ischaemia the authors prefer verapamil in order to influence the negative sequelae of secondary hyperparathyroidism. If pharmacotherapy of myocardial ischaemia is ineffective, in patients on regular dialysis treatment stress radionuclide scintigraphy or echocardiography and selective coronarography are indicated, which decide on a possible revascularization operation in these risk patients already during the pretransplantation period.