Polycythaemia vera presenting as ST-elevation myocardial infarction

A case of ST-elevation myocardial infarction as the first presentation of polycythaemia vera is described. The discussion summarises the evidence for the safety and efficacy of contemporary ST-elevation treatment strategies in the setting of polycythaemia vera.     

Spontaneous omental bleeding presenting as acute abdomen during treatment for polycythemia vera

A 54-year-old woman with polycythemia vera (PV) presented as an emergency patient with acute abdomen. Her platelet count was 119 x 10(4)/microl. Computed tomography scan revealed fluid accumulation in the omentum and peritoneal space. An emergency laparotomy was undertaken because of severe abdominal pain and omental bleeding was diagnosed. Peritoneal hemorrhage and hematoma weighing in total 1040 g was drained. Although a part of the omentum and stomach was excised, we could not find any orifice from which bleeding could have occurred despite a thorough pathological examination. Massive hemorrhage should be considered in cases with PV presenting as acute abdomen, especially when the platelet count is extremely high (over 100 x 10(4)/microl).     

以急性心肌梗死首诊的真红细胞增多症1例

急性心肌梗死发病率高,少部分急性心肌梗死继发于其他疾病,真性红细胞增多症的血栓发生机率高,但是以AMI首发并行介入治疗成功的个案少见。这些患者的病情复杂多变,治疗方法多在摸索与探讨。报道1例以PV合并AMI首诊的个案特点、诊断、治疗及随访情况,从实验室检查、药物选择、介入术式的选择几方面分析该单纯PV合并AMI,无其他危险因素的典型病例,以期探索规范化的诊疗及治疗的方案,减少死亡率,提高治愈率。     

Polycythemia vera presenting as acute myocardial infarction: An unusual presentation

Acute myocardial infarction (AMI) is usually seen in the setting of atherosclerosis and its associated risk factors. Myocardial infarction in the young poses a particular challenge, as the disease is less likely, due to atherosclerosis. We report the case of a 37-year-old female patient who presented with ST segment elevation anterolateral AMI. The only abnormality on routine blood investigation was raised hemoglobin and hematocrit. After further testing, she was diagnosed according to the World Health Organization (WHO) criteria with polycythemia vera. This case illustrates the importance of recognizing polycythemia vera as an important cause of thrombosis, which can present initially as AMI, and to emphasize the early recognition of the disease in order to initiate appropriate management strategies.     

Incidence of polycythemia vera in a defined population.

Abstract: In this retrospective investigation from Malmö, a city well-suited for epidemiologic studies, 177 patients (88 males and 89 females) with polycythemia vera (PV) were identified between 1950 and 1984. The incidence rate (number of cases/100 000/yr) in both sexes increased significantly, being 1.0 in 1950–1959 and 2.6 in 1980–1984 (adjusted to the European age-standardized population). This is the highest rate reported to date. In 1970–1984 the highest age-specific incidence rates (number of cases/100 000/yr) were found in males ≥ 80 yr and females 70–79 yr of age, being 18.3 and 14.6, respectively. A subgroup of 12 (7%) was identified where the PV diagnosis was not obvious on entry into the study but where it became clear during follow-up. 16 PV patients (9%) had verified or suspected arterial hypoxemia caused by a concomitant condition. We conclude that the increasing PV incidence rates, mainly confined to older age groups, are probably due to better case ascertainment.     

Isolated lower limb ischaemia as an unusual presenting symptom of aortic dissection

Acute aortic dissection is not common but usually presents with a severe, sharp chest pain and high blood pressure. Widening of the mediastinum is usually also evident on chest X-ray. Although acute onset of severe chest or back pain is the most common presenting symptom, some patients may present with atypical symptoms and signs. Establishing a diagnosis of aortic dissection can be difficult in the presence of atypical symptoms, especially in the absence of pain. Such presentation of aortic dissection is easily ignored. We report a case of painless aortic dissection with normal blood pressure, which resulted in acute isolated lower limb ischaemia at presentation. Atypical presentation of isolated limb arterial occlusions in an older patient without the classic symptoms are seldom reported as aortic dissection. However, aortic dissection should be included in the differential diagnosis of patients with arterial occlusive disease without chest pain and with normal blood pressure.     

Isolated right ventricular infarction presenting as anterior wall myocardial infarction on electrocardiography

Isolated right ventricle infarction is extremely rare, and its electrocardiographic (ECG) signs may be misinterpreted or even missed, especially when a typical clinical picture is lacking. This paper describes a case of isolated right ventricle infarction, recognized only by echocardiography. The patient presented with ST-segment elevation in left precordial leads together with minimal ST-segment elevation in inferior leads on a 12-lead ECG. Angiography revealed the culprit right coronary artery, which was small and non-dominant. No significant obstructions were found in the left anterior descending artery. This case demonstrates that the ECG appearance of isolated right ventricle infarction may mimic anterior wall infarction and can be easily missed if not suspected.