| [ Summary ] |
Many hemodialysis patients with ischemic heart disease do not present typical symptoms of angina pectoris. Therefore, it is important to predict the presence of myocardial ischemia from non-specific signs such as palpitation or a sense of breathlessness. Changes in routine electrocardiograms or chest X-rays such as cardiomegaly or pulmonary congestion are also predictive factors. As a result, we need to assess the presence of fluid overloads, cardiac valvular disease, or other cardiopulmonary diseases which may cause the clinical signs described above. We recommend myocardial scintigraphy as the first non-invasive method to be used for detecting myocardial ischemia. However, cardioangiography is the gold standard for diagnosing coronary artery disease. Acute myocardial infarction does not produce abnormal Q waves, and frequently occurs in association with congestive heart failure in hemodialysis patients. Therefore, it is necessary to exclude acute myocardial infarction when hemodialysis patients exhibit signs of fluid overloading. Blood biomarkers such as troponin-T are likely to produce pseudo positive results. It is important to diagnose acute myocardial infarction as soon as possible, because the prognosis is very poor for hemodialysis patients as compared to the general population. |