SHM Converge Scientific Abstract ePoster Gallery-Polycythemia Vera Presenting as St-Segment Elevation Myocardial Infarction

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This poster describes an unusual case of <strong>polycythemia vera (PV) presenting as an ST-segment elevation myocardial infarction (STEMI)</strong> in an 80-year-old woman with hypertension, prediabetes, chronic kidney disease, and a remote ischemic stroke.

She arrived at the emergency department with several hours of epigastric discomfort and malaise. Her ECG showed ST elevation in leads V4–V6 and lead I, with reciprocal ST depression in aVR, and troponin was elevated. She was treated as an acute STEMI with aspirin and ticagrelor and taken for urgent cardiac catheterization.

Angiography did not show a typical plaque rupture pattern. Instead, it revealed <strong>embolic-appearing distal occlusions</strong> in the apical LAD and a distal branch of D1, which were not suitable for PCI. This prompted evaluation for embolic causes. Telemetry showed no atrial fibrillation or other arrhythmia, echocardiography showed apical akinesis but no intracardiac thrombus, mass, or PFO, and there was no evidence of malignancy or inflammatory disease.

The most notable lab abnormality was <strong>elevated hemoglobin and hematocrit</strong>. Further testing showed a low-normal erythropoietin level and <strong>positive JAK2 V617F mutation</strong>, confirming the diagnosis of <strong>polycythemia vera</strong>. The patient was later started on hydroxyurea, and at seven-month follow-up her hemoglobin had normalized and she had no recurrent cardiovascular events.

The poster emphasizes two learning points:
1. The differential diagnosis of embolic myocardial infarction should be considered when angiography suggests embolism rather than plaque rupture.
2. <strong>Polycythemia vera is a rare but treatable cause of coronary embolism and MI</strong>, and should be included in the workup of STEMI when the presentation is atypical.

Asset Subtitle

Eric Hirsch

Meta Tag

Author List Benjamin Galen, Eric Hirsch, Lindor Qunaj

Category Clinical Vignettes

Concept Embolic Myocardial Infarction

Concept Polycythemia Vera

Concept JAK2 V617F

Concept STEMI

Concept Plaque Rupture

Distinguished Non-Finalist

Presenter Organization Montefiore Medical Center

Presenting Author Eric Hirsch

Track Adult

Keywords

polycythemia vera

STEMI

myocardial infarction

coronary embolism

JAK2 V617F

elevated hemoglobin

angiography

distal occlusion

hydroxyurea

embolic MI

Embolic Myocardial Infarction

Polycythemia Vera

JAK2 V617F

STEMI

Plaque Rupture