Johan Aris Chandran (East of England NHS UK) and Ben Coumbe (UCL medical student)
Princess Alexandra Hospital, UK
Posters & Accepted Abstracts: J Clin Exp Cardiolog
We present a case of a 55-year-old woman diagnosed with an ST-elevation myocardial infarction, on the background of receiving chemotherapy for metastatic ovarian cancer. She underwent primary angioplasty followed by a repeat angioplasty two hours later due to acute stent thrombosis. She also developed an acute ischaemic right index finger consistent with a likely embolic event. She was subsequently diagnosed to have acute severe thrombocytosis. Acute stent thrombosis is a rare complication with an incidence of between 0.1 ΓΆΒ?Β? 0.5%. The common causes of acute stent thrombosis are suboptimal stent deployment, under-sizing of the stent or accidental discontinuation of anti-platelet treatment. In this case, our patient had no identifiable cardiovascular risk factors, and it may be possible that the initial event may also have been due to severe thrombocytosis. The systemic anti-cancer treatment she was receiving at the time was not known to be associated with increased cardiovascular risk. The recurrent stent thrombosis that occurred in this setting was, however, likely due to the significant reactive thrombocytosis. The underlying cause of the thrombocytosis is critical in determining the appropriate management of the condition. In this case, the aetiology is a subject for debate and may not be solely attributable to being secondary to the cardiac event. The observed thrombocytosis could potentially be explained by the side effect of gemcitabineinduced thrombocytosis or an inflammatory reaction from the primary cancer. This case highlights the role of exploring a broad differential diagnosis in cases of recurrent acute stent thrombosis, and is a very rare case of reactive thrombocytosis in a patient on systemic anti-cancer treatment presenting as a myocardial infarction. It highlights the benefits of inter-specialty liaison for delivering better patient care especially in complicated treatment regimes for a number of disorders in various medical specialties.
Johan Aris Chandran (MA, MB BChir) is currently a core medical trainee at the Princess Alexandra Hospital, UK and intends to pursue cardiology as a future career.