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Case Report
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| Polycythemia vera and microvascular dysfunction in a 26-year-old male presenting with chest pain | ||||||
| Erika Jones1, Nava Greenfield2, Puja K. Mehta1, Chrisandra Shufelt1, Louise Thomson3, C. Noel Bairey Merz1 | ||||||
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1MD, Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, USA.
2MD, SUNY Downstate Medical Center, Brooklyn, NY, USA. 3MBChB, FRACP, S. Mark Taper Foundation Imaging Center, Cedars-Sinai Heart Institute, Los Angeles, CA, USA. | ||||||
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| How to cite this article |
| Jones E, Greenfield N, Mehta PK, Shufelt C, Thomson L, Merz CNB. Polycythemia vera and microvascular dysfunction in a 26-year-old male presenting with chest pain. Int J Case Rep Images 2015;6(5):305–308. |
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Abstract
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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. | |
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Keywords:
Chest pain, Coronary endothelial dysfunction, Coronary reactivity testing, Microvascular dysfunction, Polycythemia vera
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Author Contributions
Erika Jones – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published Nava Greenfield – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published Puja K. Mehta – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published Chrisandra Shufelt – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published Louise Thomson – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published C. Noel Bairey Merz – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published |
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Guarantor of submission
The corresponding author is the guarantor of submission. |
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Source of support
None |
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Conflict of interest
Authors declare no conflict of interest. |
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Copyright
© 2015 Erika Jones et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information. |
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