Polycythemia vera and microvascular dysfunction in a 26-year-old male presenting with chest pain

Erika Jones, Nava Greenfield, Puja K. Mehta, Chrisandra Shufelt, Louise Thomson, C. Noel Bairey Merz
2015 International Journal of Case Reports and Images  
International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties. Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. ABSTRACT Introduction:
more » ... TRACT 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 pathophysiology is not well understood. In our patient no thrombus was visualized on angiogram. Conclusion: The findings of his CRT in the setting of PV offer an interesting link between hematological disorders, endothelial dysfunction, and persistent chest pain with no obstructive CAD. 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
doi:10.5348/ijcri-201550-cr-10511 fatcat:fafv2fnjnvdffo5uqu2r35gerq