Mali Padmavathi, Muduganti Sudheer, Buddemeier Kamilla J
WMJ. 2015 Feb;114(1):26-9.
A 50-year-old man was admitted to the hospital with left shoulder and arm discomfort. He had no recent history of change in his energy level, limitations to activity, exertional chest pain, or shortness of breath. He had cardiac risk factors, including a strong family history of pre-mature coronary artery disease and dyslipidemia. He had a syncopal episode in 2003 with a positive troponin I, but had a negative cardiac workup, including cardiac catheterization that showed luminal irregularities and no significant coronary artery disease. An echocardiogram was performed to rule out potential cardiac causes for shoulder pain and showed regional wall motion abnormalities. Follow-up cardiac catheterization revealed left anterior descending artery proximal and mid dissection and a long area of dissection in the first diagonal branch. Laboratory evaluation showed significant platelet elevation and positive JAK2 study. Ultrasound of the abdomen revealed moderate splenomegaly. The enlarged spleen, positive JAK2 study, and persistently elevated platelet count confirmed the diagnosis of essential thrombocythemia. Essential thrombocythemia can predispose individuals to vascular dysfunction and damage, which may contribute to coronary artery dissection. With this case, we propose that essential thrombocythemia should be excluded in the presence of coronary dissection and thrombocytosis.
一名50岁男性因左肩和手臂不适入院。他近期没有精力水平变化、活动受限、劳力性胸痛或呼吸急促的病史。他有心脏危险因素，包括早发冠状动脉疾病和血脂异常的家族史。他在2003年有一次晕厥发作，肌钙蛋白I阳性，但心脏检查结果为阴性，包括心脏导管检查显示管腔不规则但无明显冠状动脉疾病。进行了超声心动图检查以排除肩部疼痛的潜在心脏原因，结果显示局部室壁运动异常。后续心脏导管检查发现左前降支近端和中段夹层以及第一对角支的长段夹层。实验室检查显示血小板显著升高且JAK2检测呈阳性。腹部超声显示脾脏中度肿大。脾脏肿大、JAK2检测呈阳性以及血小板计数持续升高证实了原发性血小板增多症的诊断。原发性血小板增多症可使个体易患血管功能障碍和损伤，这可能导致冠状动脉夹层。通过这个病例，我们提出在存在冠状动脉夹层和血小板增多症的情况下应排除原发性血小板增多症。
