Limits...
Acute Non-Atherosclerotic ST-Segment Elevation Myocardial Infarction in an Adolescent with Concurrent Hemoglobin H-Constant Spring Disease and Polycythemia Vera.

Rattarittamrong E, Norasetthada L, Tantiworawit A, Chai-Adisaksopha C, Hantrakool S, Rattanathammethee T, Charoenkwan P - Hematol Rep (2015)

Bottom Line: Coronary artery angiography revealed an acute clot in the right coronary artery without atherosclerotic plaque.He was treated with plateletpheresis, hydroxyurea and antiplatelet agents.This case represents the importance of early diagnosis, awareness of the increased risk for thrombotic complications, and early treatment of PV in patients who have underlying thalassemia with marked thrombocytosis.

View Article: PubMed Central - PubMed

Affiliation: Division of Hematology, Department of Internal Medicine.

ABSTRACT
Thrombosis is a major complication of polycythemia vera (PV) and also a well-known complication of thalassemia. We reported a case of non-atherosclerotic ST-segment elevation myocardial infarction (STEMI) in a 17-year-old man with concurrent post-splenectomized hemoglobin H-Constant Spring disease and JAK2 V617F mutation-positive PV. The patient initially presented with extreme thrombocytosis (platelet counts greater than 1,000,000/µL) and three months later developed an acute STEMI. Coronary artery angiography revealed an acute clot in the right coronary artery without atherosclerotic plaque. He was treated with plateletpheresis, hydroxyurea and antiplatelet agents. The platelet count decreased and his symptoms improved. This case represents the importance of early diagnosis, awareness of the increased risk for thrombotic complications, and early treatment of PV in patients who have underlying thalassemia with marked thrombocytosis.

No MeSH data available.


Related in: MedlinePlus

Electrocardiogram (ECG) of the patient showing normal sinus rhythm with occasional premature ventricular contractions (PVC). ST elevation in leads II, III, aVF with ST depression in leads I, aVL, and V1-V6 were noted. These findings were compatible with an acute ST-elevation myocardial infarction (STEMI) of the inferior wall.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4591500&req=5

fig002: Electrocardiogram (ECG) of the patient showing normal sinus rhythm with occasional premature ventricular contractions (PVC). ST elevation in leads II, III, aVF with ST depression in leads I, aVL, and V1-V6 were noted. These findings were compatible with an acute ST-elevation myocardial infarction (STEMI) of the inferior wall.

Mentions: Three months later, the patient was admitted to the hospital due to chest pain. His electrocardiogram (ECG) showed an ST elevation in leads II, III, aVF and ST depression in leads V1-V6 as shown in Figure 2. Cardiac enzymes were elevated as follows: total CK of 2298 U/L (normal range 0-195), CK-MB of 209 ng/mL (normal range 0.63-5.1), and troponin T of 2.34 ng/mL (normal <0.01). Acute STEMI was diagnosed. Coronary artery angiography revealed an acute clot in mid right coronary artery (RCA) and irregular surface of proximal RCA suspected white clot. The findings showed that he was unlikely to have atherosclerotic plaque. His CBC still showed marked thrombocytosis with platelet of 2,278,000/µL, Hb of 9.5 g/dL, and WBC of 29,200/µL (neutrophils 66%, lymphocytes 16%). Echocardiography revealed good left ventricular systolic function with an ejection fraction of 61.6%. The patient was a non-smoker and laboratory testing for other cardiovascular risk factors were negative as follows: fasting blood sugar (FBS) of 74 mg/dL, total cholesterol of 121 mg/dL, low density lipoprotein (LDL) cholesterol of 54 mg/dL, high density lipoprotein (HDL) cholesterol of 24 mg/dL, triglyceride of 141 mg/dL, blood urea nitrogen (BUN) of 13 mg/dL, creatinine of 0.7 mg/dL, and uric acid of 6.5 mg/dL.


Acute Non-Atherosclerotic ST-Segment Elevation Myocardial Infarction in an Adolescent with Concurrent Hemoglobin H-Constant Spring Disease and Polycythemia Vera.

Rattarittamrong E, Norasetthada L, Tantiworawit A, Chai-Adisaksopha C, Hantrakool S, Rattanathammethee T, Charoenkwan P - Hematol Rep (2015)

Electrocardiogram (ECG) of the patient showing normal sinus rhythm with occasional premature ventricular contractions (PVC). ST elevation in leads II, III, aVF with ST depression in leads I, aVL, and V1-V6 were noted. These findings were compatible with an acute ST-elevation myocardial infarction (STEMI) of the inferior wall.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4591500&req=5

fig002: Electrocardiogram (ECG) of the patient showing normal sinus rhythm with occasional premature ventricular contractions (PVC). ST elevation in leads II, III, aVF with ST depression in leads I, aVL, and V1-V6 were noted. These findings were compatible with an acute ST-elevation myocardial infarction (STEMI) of the inferior wall.
Mentions: Three months later, the patient was admitted to the hospital due to chest pain. His electrocardiogram (ECG) showed an ST elevation in leads II, III, aVF and ST depression in leads V1-V6 as shown in Figure 2. Cardiac enzymes were elevated as follows: total CK of 2298 U/L (normal range 0-195), CK-MB of 209 ng/mL (normal range 0.63-5.1), and troponin T of 2.34 ng/mL (normal <0.01). Acute STEMI was diagnosed. Coronary artery angiography revealed an acute clot in mid right coronary artery (RCA) and irregular surface of proximal RCA suspected white clot. The findings showed that he was unlikely to have atherosclerotic plaque. His CBC still showed marked thrombocytosis with platelet of 2,278,000/µL, Hb of 9.5 g/dL, and WBC of 29,200/µL (neutrophils 66%, lymphocytes 16%). Echocardiography revealed good left ventricular systolic function with an ejection fraction of 61.6%. The patient was a non-smoker and laboratory testing for other cardiovascular risk factors were negative as follows: fasting blood sugar (FBS) of 74 mg/dL, total cholesterol of 121 mg/dL, low density lipoprotein (LDL) cholesterol of 54 mg/dL, high density lipoprotein (HDL) cholesterol of 24 mg/dL, triglyceride of 141 mg/dL, blood urea nitrogen (BUN) of 13 mg/dL, creatinine of 0.7 mg/dL, and uric acid of 6.5 mg/dL.

Bottom Line: Coronary artery angiography revealed an acute clot in the right coronary artery without atherosclerotic plaque.He was treated with plateletpheresis, hydroxyurea and antiplatelet agents.This case represents the importance of early diagnosis, awareness of the increased risk for thrombotic complications, and early treatment of PV in patients who have underlying thalassemia with marked thrombocytosis.

View Article: PubMed Central - PubMed

Affiliation: Division of Hematology, Department of Internal Medicine.

ABSTRACT
Thrombosis is a major complication of polycythemia vera (PV) and also a well-known complication of thalassemia. We reported a case of non-atherosclerotic ST-segment elevation myocardial infarction (STEMI) in a 17-year-old man with concurrent post-splenectomized hemoglobin H-Constant Spring disease and JAK2 V617F mutation-positive PV. The patient initially presented with extreme thrombocytosis (platelet counts greater than 1,000,000/µL) and three months later developed an acute STEMI. Coronary artery angiography revealed an acute clot in the right coronary artery without atherosclerotic plaque. He was treated with plateletpheresis, hydroxyurea and antiplatelet agents. The platelet count decreased and his symptoms improved. This case represents the importance of early diagnosis, awareness of the increased risk for thrombotic complications, and early treatment of PV in patients who have underlying thalassemia with marked thrombocytosis.

No MeSH data available.


Related in: MedlinePlus