ACUTE MYOCARDIAL INFARCTION: AN UNUSUAL INITIAL PRESENTATION OF POLYCYTHEMIA VERA

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Polycythemia Vera (PV) is a chronic myeloproliferative disorder that affects the hematopoietic progenitor cells and increases production of red cells, platelets granulocytes1. The incidence PV around 2.3 per 100,000 persons/year2. Major cause morbidity mortality in patients thrombosis either microcirculatory or arterial4. Hyperviscosity thrombocytosis lead to coronary resulting acute myocardial infarction (AMI)4. However, initial presentation as AMI extremely rare, with less than 10 cases reported literature4. This unique case young healthy male no cardiovascular risk factors, who presented an ultimate diagnosis PV. CASE PRESENTATION: A 42-year-old French severe substernal chest pain radiating left arm, nausea, diaphoresis arm numbness ongoing for hour. He had significant medical, social family history. HR 101 BPM BP 137/92 mmHg. Labs included: high sensitivity troponin 701 pg/mL, LDL 111mg/dL, WBC 11.7K, 357K, Hgb 22.5 g/dL Hct 67.6%. An EKG was suggestive antero-septal STEMI. cardiac catheterization drug eluting stent deployed anterior descending artery 99% occluded. findings elevated hemoglobin hematocrit triggered cascade investigations. Erythropoietin level unremarkable, while bone marrow biopsy displayed panmyelosis. Imaging demonstrated hepatosplenomegaly. Ultimately, established when genetic testing revealed JAK2 V617F mutation. Post-MI treatment hydroxyurea therapeutic phlebotomies maintain goal 45% initiated. DISCUSSION: Coronary events occur at rate 11.4% 10-year follow-up4. two most important factors are advanced age prior history thrombosis1. Although not clearly established, overproduction thromboxane A2, endothelial dysfunction, platelet leukocyte activation believed contribute vascular events4. mainstay antiplatelet medications, cytoreductive drugs4. There current guidelines reduction restenosis PV1. CONCLUSIONS: emphasizes need consider differential syndrome without any factors. Furthermore, it re-affirms annual examination identify abnormal studies benefit timely intervention. REFERENCE #1: Adel G. Acute Syndromes: Pathogenesis, Risk Factors Treatment. J Hematol Thromboembolic Dis. 2013;01(01). doi:10.4172/2329-8790.1000107 #2: Bahbahani H, Aljenaee K, Bella A. vera presenting infarction: unusual presentation. Saudi Hear Assoc. 2015;27(1):57-60. doi:10.1016/j.jsha.2014.07.003 #3: Tefferi A, Rumi E, Finazzi G, et al. Survival prognosis among 1545 contemporary polycythemia vera: international study. Leukemia. 2013;27(9):1874-1881. doi:10.1038/leu.2013.163 DISCLOSURES: No relevant relationships by Madeeha Banu, source=Web Response Rohan Bodapati, palak desai, Brendan Gilmore, Kenneth Joseph, nitish singh nandu, Swetha Paduri, Nehal Patel,