Abstract
Introduction: Essential thrombocytosis (Et) is a myeloproliferative disorder with higher incidence of thrombotic events. to our knowledge, we present the first case of st-segment elevation myocardial infarction (stEMI) secondary to paradoxical right coronary artery (rcA) embolus through a patent foramen ovale (PFO) in a patient with essential thrombocytosis and pulmonary embolus. case report: A 67-year old female with a history of Et presented to the emergency room with dyspnea. Physical examination revealed an elevated JVP, an s1Q3t3 pattern on her presenting EcG, and an elevated D-dimer. V/Q scan showed a high probability for pulmonary embolism as well as unusual evidence of right-to-left cardiac shunting. After starting low molecular weight heparin, she developed new-onset chest
Highlights
Essential thrombocytosis (ET) is a myeloproliferative disorder with higher incidence of thrombotic events
We present the first case of ST-segment elevation myocardial infarction (STEMI) secondary to paradoxical right coronary artery (RCA) embolus through a patent foramen ovale (PFO) in a patient with essential thrombocytosis and pulmonary embolus
We present a patient with ET and an unusual presentation of inferior myocardial infarction secondary to paradoxical embolus through a patent foramen ovale (PFO) in the setting of acute pulmonary embolism
Summary
Essential thrombocytosis (ET) is a myeloproliferative disorder characterized by pathological clonal proliferation of megakaryocytes and thrombocythemia [1]. Presenting ECG showed a typical S1Q3T3 pattern and symmetric T-wave inversion in anterior precordial leads (Figure 1). Repeat ECG revealed ST-segment elevation in leads II, III and aVF consistent with STEMI (Figure 3) She was immediately intubated, started on dopamine and taken for cardiac catheterization. The patient did well post coronary thrombectomy and systemic thrombolysis with no further thrombotic sequelae or hemorrhagic complications She was started on unfractionated heparin and transferred to the cardiology ward one week later. She was transitioned to warfarin with a target INR between 2 and 3, and Figure 1: Electrocardiography at presentation, S1Q3T3 pattern and symmetric T wave inversion in anterior precordial leads indicating right ventricular strain. The patient was done well on medical therapy, symptom free at three-year follow-up
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