Heidi M. Crane M.D.              Washington University
Acute myocardial infarction as an unusual presentation of chronic myelogenous leukemia 
         
 

Introduction: Chronic myelogenous leukemia is a rare hematological neoplasm ( less than 15% of leukemias). Patients typically present with fatigue, headache, weight loss or are diagnosed from routine leukocyte counts obtained for other reasons. This is an unusual case of a young woman with no cardiac risk factors who presented with an acute myocardial infarction.

Case: A 48-year-old female with no significant past medical history was admitted to the hospital after one week of chest pain. Pain typically began at night, usually at rest, often would wake patient from sleep. Initially pain did not radiate nor was it associated with nausea, vomiting, or diaphoresis. On night of admit pain was more severe than previously, it radiated to her left arm, and she vomited two times. At that point she went to the hospital. After receiving aspirin and nitrates patient had substantial reduction in pain. Initial laboratory studies showed a troponin level of 4.1, a white blood cell count of 88,000, a platelet count of 2.4 million, and a hematocrit of 36. An EKG revealed a sinus tachycardia with T wave inversions in V2 and V3, an echocardiogram showed apical akinesis and anteroseptal hypokinesis. A cardiac catheterization demonstrated a 90% LAD lesion which was treated with percutaneous tranSt. Louis University  minal coronary angioplasty as well as a stent, in addition, spasm was present at other sites, No reoccurrence of chest pain occurred after the cardiac catheterization. Patient’s treatment included platelet phoresis, aspirin, plavix, calcium channel blockers, and initially hydroxyurea myelogenous leukemia. Patient recovered uneventfully from the acute event.