Abstract
Introduction: signs and symptoms of myocardial ischemia in the setting of no obstructive coronary artery disease (cAD) is often found in women. One of the mechanisms thought to contribute is coronary vascular dysfunction (cVaD). coronary reactivity testing (crt) is used to assess endothelial and non-endothelial dependent cVaD, but is not routinely performed. case report: We report a case of a healthy 26-year-old male with persistent chest pain after st elevation myocardial infarction with normal coronary arteries. stress cardiac magnetic resonance imaging showed normal rest and stress first pass perfusion, with an incidental finding of an enlarged spleen. He underwent crt and was found to have slow flow and coronary endothelial dysfunction. Due to his enlarged spleen and an elevated hematocrit at 50% he was referred to a hematologist and diagnosed with polycythemia vera (PV). Although the risk of thrombosis and myocardial infarction is known in PV, the
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