Pharmacotherapy of silent myocardial ischemia in patients on hemodialysis

: 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.