%0 Journal Article
%T One Case of Primary Thrombocythemia with Concealed Hypokalemia Complicated by Acute Myocardial Infarction
%A Huiling Liang
%A Tingting Zheng
%A Yuanhong Zhuo
%J World Journal of Cardiovascular Diseases
%P 16-26
%@ 2164-5337
%D 2024
%I Scientific Research Publishing
%R 10.4236/wjcd.2024.141003
%X Medical history summary: Male, 47 years old, was admitted to the hospital due to ˇ°dizziness accompanied
by chest tightness and pain for more than 8 daysˇ±. One week ago, the patient
experienced chest tightness, chest pain accompanied by profuse sweating for 3
hours and underwent emergency percutaneous
coronary intervention (PCI) at a local hospital. The procedure revealed left
main stem occlusion with subsequent left main stem to left anterior
descending artery percutaneous transluminal coronary angioplasty (PTCA). After
the procedure, the patient experienced hemodynamic instability, recurrent
ventricular fibrillation, and critical condition, thus transferred to our
hospital for further treatment. Symptoms and signs: The
patient is in a comatose state, unresponsive to stimuli, with bilateral dilated
pupils measuring 2.0 mm, exhibiting reduced sensitivity to light reflex, and
recurrent fever. Coarse breath sounds can be
heard in both lungs, with audible moist rales. Irregular breathing pattern is observed, and heart sounds vary
in intensity. No pathological murmurs are auscultated in any valve auscultation
area. Diagnostic methods: Coronary angiography
results at the local hospital showed complete occlusion of the left main stem,
and left main stem to left anterior descending artery percutaneous transluminal
coronary angioplasty (PTCA) was performed. However, the distal guidewire did
not pass through. After admission, blood tests showed a Troponin T level of
1.44 ng/ml and a Myoglobin level of 312 ng/ml. The platelet count was 1390 ˇÁ 109/L.
Von Willebrand factor (vWF) activity was measured at 201.9%. Bone marrow
aspiration biopsy showed active bone marrow proliferation and platelet
clustering. The peripheral blood smear also showed platelet clustering. JAK-2
gene testing was positive, confirming the diagnosis of primary thrombocytosis. Treatment methods: The patient is assisted with mechanical ventilation and
intra-aortic balloon counterpulsation to improve coronary blood flow.
Electrolyte levels are closely monitored, especially maintaining plasma
potassium levels between 4.0 and 4.5 mmol/l.
Hydroxyurea 500 mg is administered for platelet reduction. Anticoagulants and
antiplatelet agents are used rationally to prevent
%K Primary Thrombocythemia
%K Acute ST-Segment Elevation Myocardial Infarction
%K Concealed Hypokalemia
%K Thrombosis
%K Bleeding
%U http://www.scirp.org/journal/PaperInformation.aspx?PaperID=130562