Abstract
A 61-year-old female dialysis patient with stable angina was observed while on coronary vasodilator therapy. Because her condition became unstable with an increase in the frequency of anginal attacks, cardiac catheterization was performed. Ninety-percent stenosis of the left main trunk was demonstrated, precluding the possibility of percutaneous transluminal coronary angioplasty, and A-C bypass surgery was indicated. Marked discomfort, however, developed in the chest during dialysis 7 days before the scheduled operation. This attack of angina was not relieved by the administration of a coronary vasodilator, and the patient lapsed into shock. Her blood pressure was restored by vasopressor medication, but the long duration of the attack suggested transition from unstable angina to threatened infarction. An emergency A-C bypass procedure was performed, and the angina disappeared. Emergency operation of dialysis patients is considered to involve high risk, but it can be performed with sufficient maintenance dialysis and appropriate postoperative management.
