Acute Myocardial Infarction With Polycythemia Vera: A Rare Case

Abstract

Introduction: Polycythemia Vera (PV) is one of the chronic myeloproliferative disorders that is rarely found, with a prevalence according to WHO around 2.3/100,000 inhabitants. The complication of PV is thrombosis, bleeding, and transformation into leukemia. Coronary events are common during the course of PV, approximately 11.4 % of patients had a myocardial infarction. Case: A 65-year-old male presented with complaints of chests pain accompanied by cold sweat, nausea, and vomiting. There was no organomegaly. Laboratory results showed Hb 23.2g/dL, HCT 72.1%, RBC 9.4 x106/uL, WBC 21,000/?L, PLT 470,000/uL. CKMB 56.1 U/L, Troponin T 1,751 pg/mL. ECG examination showed: ST elevation in lead V2-V4. The molecular result obtained the positive mutation of JAK2V617F. Discussion: Polycythemia Vera, in this case, was diagnosed based on the 2008 WHO criteria, which consisted of major criteria such as Hb> 18.5 g/dl in males and an increase in red blood cell volume; and the presence of JAK2V617F mutation, while Acute myocardial infarction (AMI) diagnosis in this case was based on the elevation of cardiac markers and ECG result. Acute myocardial infarction in PV was largely due to high RBC mass which increased blood viscosity. Conclusion: This patient was diagnosed with polycythemia vera and acute myocardial infarction based on clinical examination, laboratory results, and ECG. One of the aims of good management in PV is reducing cardiovascular events which is the main cause of morbidity and mortality.