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Polycythemia Vera as the Main Risk Factor in ST Elevation Myocardial Reinfarction

Author : W.D.S. Cyndiana, B. Kris, A. Wayan
Upload Date : 19-04-2018

Background: Polycythaemia vera is a chronic myeloproliferation disease, involving hematopoietic progenitor cells that can lead cause of acute myocardial infarction with risk of reinfarction and high mortality rate.     

Case Ilustration: The 74-year-old female patient came to the emergency room on complained with a stiff on the jaw in late onset, accompanied by cold sweats and nausea, with no chest pain and reffered pain. There’s no history of heart failure. She had polycythemia vera and hypertension since 2 years ago, history of stroke since 1 year ago, dyslipidemia, menopause and also had been suspected of having previous CAD and had done coronary angiography on 1 year ago with normal result. The ECG investigations found st elevation in leads II, III and aVF and st deppresion in leads V4 to V6, I and aVL. Labs results was hemoconcentration, thrombocytosis and dyslipidemia. Echo results found RMWA in basal-mid septal and basal- mid inferior. Elective PCI was performed with the result of 85% stenosis in proximal RCA and had placement DES stents on proximal RCA with treatment dual antiplatelet and hydroxyurea.

Discussion: Several studies have shown that Polycythaemia vera can cause increased hematocrit, blood hypervicoscity, platelet buildup stimulation, thrombogenesis, the presence of leucocytosis, fragile membranes and intimal proliferation. Patients over 60 with a history of thrombosis are at high risk, which recommendation therapy using cytoreductive agents (such as hydroxyurea or interferon-α) and combination of aspirin with long-term clopidogrel is very effective to prevent the occurrence of recurrent thrombosis of about 58%.

Conclusion: The difficulty in patients with polycythemia vera that experience acute myocardial infarction is to regulate the coronary arteries to remain patent against recurrent thrombosis and prevent the occurrence of risk of thrombosis in the stent in the future.

KEYWORDS : polycythemia vera, thrombosis, acute coronary syndrome, dual antiplatelet


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