ABC | Volume 114, Nº4, Suplement, April 2020

Case Report Silveira et al. Acute myocardial infarction in polycythemia vera Arq Bras Cardiol 2020; 114(4Suppl.1):27-30 resonance imaging (Figure 2C), which showed late enhancement of ischemic pattern, compatible with fibrotic area defining infarction of the medium and apex portion of the inferior wall, with preserved ejection fraction. Abdomen ultrasound confirmed homogeneous splenomegaly and low erythropoietin (1,5 mUI/mL; reference 5.4–31.9 mUI/mL), and JAK-2 mutation confirmed our hypothesis. He was then started on hydroxyurea, clopidogrel was suspended and anticoagulation was kept until discharge (8 days). The patient evolved without complications during his in-hospital stay or during early follow-up. Discussion We report here a very rare case of first presentation of PV as AMI. To our knowledge, fewer than 10 cases similar to this have been reported so far. 3 Usually, the patients are diagnosed with PV and, later, present some form of coronary acute syndrome, in about 11.4% of cases. 4 Our patient had only hypertension and age as risk factors, and had no significant alterations in lipid profile, fasting glucose level, renal function or family history that could have increased the risk of developing AMI. In this patient’s case, there were two conditions that could have contributed to myocardial Figure 1 – Electrocardiograms: at admission (a) with pathologic Q wave, inversion of T wave in DII, DIII and aVF, and asymmetric inversion of T wave in the precordial leads (V4–V6); and 1 hour after (b) with ST segment elevation in DII, DIII and aVF, keeping the other characteristics. 28