SHM Converge Scientific Abstract ePoster Gallery-Double Jeopardy: Nstemi and Stroke Unmasking Polycythemia Vera

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This poster presents a 72-year-old man whose polycythemia vera (PV) was first recognized after acute cardiovascular and neurologic symptoms. He had weeks to a year of worsening vertigo, tinnitus, diplopia, gait instability, and restless legs, then developed nausea, vomiting, substernal chest pain, and thoracic back pain. Exam showed horizontal nystagmus, facial plethora, and an unsteady gait.<br /><br />Initial labs revealed marked pancytosis: hemoglobin 23 g/dL, WBC 25 ×10³/µL, and platelets 841 ×10³/µL, with elevated bilirubin, troponin, and BNP. Imaging and cardiac workup showed chronic lacunar infarcts on CT head, diffuse T-wave inversions and Q waves on ECG, a reduced ejection fraction (45%) with regional wall motion abnormalities, and severe coronary artery disease on catheterization. CT angiography excluded aortic dissection. Follow-up studies showed iron deficiency, low EPO, elevated uric acid/LDH, and JAK2 V617F positivity, confirming PV.<br /><br />He was diagnosed with NSTEMI secondary to PV-related hyperviscosity and thrombosis. Treatment included aspirin, atorvastatin, metoprolol, two phlebotomies, and hydroxyurea, which was adjusted due to neutropenia. CABG was considered too high risk, and stenting was not performed. At one-month follow-up, symptoms were controlled and hematocrit was at goal.<br /><br />The poster emphasizes that PV is a JAK2-driven myeloproliferative neoplasm causing erythrocytosis, thrombocytosis, leukocytosis, hyperviscosity, endothelial injury, and hypercoagulability. It increases risk of myocardial infarction, stroke, and heart failure, sometimes before the hematologic disorder is recognized. The authors stress the importance of considering PV in patients with unexplained microvascular symptoms or major cardiovascular events.

Asset Subtitle

Nina G. Howard

Meta Tag

Author List Nina G. Howard, Philip K. Angelides

Category Clinical Vignettes

Concept Polycythemia Vera

Concept Primary erythrocytosis

Concept JAK2 Testing

Concept Hyperviscosity Syndrome

Concept Hypercoagulable State

Distinguished Non-Finalist

Presenter Organization Baylor College of Medicine

Presenting Author Nina G. Howard

Track Adult

Keywords

polycythemia vera

JAK2 V617F

hyperviscosity

NSTEMI

thrombosis

erythrocytosis

thrombocytosis

leukocytosis

myeloproliferative neoplasm

cardiovascular events

Polycythemia Vera

Primary erythrocytosis

JAK2 Testing

Hyperviscosity Syndrome

Hypercoagulable State