Diagnosis of acute myocardial infarction in patients with renal failure

This is an automatically translated article.

The article was consulted with Master, Doctor Tran Hong Nhat - Interventional Cardiologist - Cardiovascular Center - Vinmec Central Park International General Hospital.
Patients with chronic kidney failure face a high risk of cardiovascular diseases such as acute coronary syndrome, myocardial infarction,... Myocardial infarction in chronic renal failure can lead to death with a high rate. Diagnosis of acute myocardial infarction in patients with renal failure can be based on test results of elevated troponin levels.

1. Myocardial infarction in chronic renal failure

Patients with chronic renal failure have a higher risk of coronary artery disease such as acute coronary syndrome and lead to a high mortality rate. Patients with end-stage renal failure are at high risk for acute ischemic myocardial infarction, which is characterized by atypical chest pain.
However, the diagnosis of acute myocardial infarction in patients with chronic renal failure is difficult because the test results of cardiac markers are higher than in patients without renal failure and are easily confused with suspected patients. acute coronary syndrome.
MORE: Learn troponin test in the diagnosis of myocardial infarction

2. Increased troponin in chronic renal failure

Studies have shown that blood troponin levels are increased in patients with chronic renal failure, whether or not chest pain is present, in which, most commonly, elevated troponin T (TnT). TnT is also increased in patients with chronic renal failure on dialysis but without symptoms of acute coronary syndrome, and troponin I (TnI) increases by about 5% less than TnT. TnT and TnI were not affected by dialysis, and TnT and TnI concentrations before and after dialysis were unchanged. In addition, elevated troponin in patients with chronic renal failure may also be due to concomitant congestive heart failure and hypertension.
MORE: ️What is Troponin test and its application?

3. Diagnosis of myocardial infarction in chronic renal failure

Based on troponin elevation alone to diagnose acute myocardial infarction in patients with chronic renal failure is very difficult because there is no evidence of myocardial damage and difficult to distinguish from patients with suspected acute coronary syndrome. In order to diagnose acute myocardial infarction in patients with renal failure, in addition to troponin, attention should be paid to other biomarkers and kinetic markers of troponin changes, specifically:
Elevated but stable troponin levels in patients with chronic renal failure without evidence of myocardial damage. All troponins above the 99th percentile bvi5 of the upper limit of normal and a change of more than 20% between the two tests were considered thresholds for the diagnosis of myocardial infarction. Cardiac markers should be observed and repeated after 6-9 hours to confirm or exclude acute coronary syndrome when diagnosing myocardial infarction in chronic renal failure. It is necessary to rely on the change in the kinetics of the increase or decrease of troponin to confirm and differentiate acute myocardial infarction in patients with chronic renal failure. In patients with renal failure undergoing dialysis, CK-MB levels are increased but not TnI. Myoglobin is also elevated in patients with chronic renal failure. To diagnose acute myocardial infarction in patients with chronic renal failure, it is necessary to repeat the troponin test for the first time and after 1-3 hours to identify, differentiate and exclude from the acute coronary syndrome.
With many years of experience in the examination and treatment of cardiovascular diseases, now Vinmec International General Hospital has become one of the major Cardiology centers, possessing a team of qualified doctors and nurses. , be trained. In addition, for early diagnosis of myocardial infarction, as well as many other cardiovascular diseases, Vinmec is also equipped with state-of-the-art equipment and facilities for cardiovascular diagnostics such as 2D, 3D echocardiography with full Full features of transesophageal and chest wall ultrasound, electrocardiogram machine, Holter blood pressure machine, Holter electrocardiogram machine, stress ECG machine: Running mat, tilt bike, tilt test...
Special At Vinmec, there is also a Hybrid Operating Room with state-of-the-art equipment such as DSA angiography machine, integrated anesthesia machine that brings the highest efficiency in the treatment of cardiovascular diseases such as combined surgery and angioplasty intervention, coronary stent placement with the most modern minimally invasive technique.
Therefore, with the diagnosis of acute myocardial infarction, patients with renal failure will soon be detected and promptly treated, avoiding potentially dangerous complications.

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