Acute myocardial infarction as a finding of acute promyelocytic leukemia–related coagulation disorder

Abstract

Acute promyelocytic leukemia (APL) has one of the most favorable prognoses among other leukemia subtypes. However, the major cause of mortality in APL is disseminated intravascular coagulation at the presentation. We present a case of acute myocardial infarction (MI) at the time of APL diagnosis before treatment. The patient suffered from chest pain, sweating and giddiness. He was hypoxic, hypotensive and bradycardic. ECG showed inferior MI. Unfractioned heparin infusion (850 U/h) was started and 5 min after the previous ECG showed total ST resolution. We suggest that in this case, MI was not related to atherosclerotic plaque rupture but related to DIC manifestation.

A Leucemia Mieloide Aguda Poderia ter se Apresentado Ainda Pior? “Causa Incomum de Trombose Multiarterial Concomitante”

“… 3 , 11 Um relato de caso afirmou que IAMSST inferior se desenvolveu em um paciente LPA com CID, e a síndrome coronariana aguda regrediu dramaticamente em um curto período de tempo com infusão de heparina. 12 Os autores consideraram que a etiologia da síndrome coronariana aguda do paciente foi devida à CID e não à ruptura da placa aterosclerótica. 12 Casos de IAM não trombótico secundário a hiperleucocitose e leucostase e IAM trombótico secundário a CID têm sido relatados na literatura.…”

“… 12 Os autores consideraram que a etiologia da síndrome coronariana aguda do paciente foi devida à CID e não à ruptura da placa aterosclerótica. 12 Casos de IAM não trombótico secundário a hiperleucocitose e leucostase e IAM trombótico secundário a CID têm sido relatados na literatura. 13 , 14 Curiosamente, neste caso que apresentamos, não houve hiperleucocitose, leucostase ou CID.…”

“… 3 , 11 A case report stated that inferior STEMI developed in an APL patient with DIC, and acute coronary syndrome regressed dramatically quickly with heparin infusion. 12 The authors considered that the etiology of the patient’s acute coronary syndrome was due to DIC and not to atherosclerotic plaque rupture. 12 Cases of non thrombotic AMI secondary to hyperleukocytosis and leukostasis and thrombotic AMI secondary to DIC have been reported in the literature.…”

“… 12 The authors considered that the etiology of the patient’s acute coronary syndrome was due to DIC and not to atherosclerotic plaque rupture. 12 Cases of non thrombotic AMI secondary to hyperleukocytosis and leukostasis and thrombotic AMI secondary to DIC have been reported in the literature. 13 , 14 Interestingly, in this case we have presented, there was no hyperleukocytosis, leukostasis or DIC.…”

New perspectives on treatment strategies for patient with acute myeloid leukemia and complex karyotype abnormalities after percutaneous coronary intervention

“…It was found that patients with acute promyelocytic leukemia have been reported in many literatures. [11,12] On the one hand, APL is the underlying cause of CHD, and APL-associated thrombosis events are associated with leukemia and the interaction between malignant promyelocytes and host cells. [13] On the other hand, APL patients with bleeding are well known, high incidence of early hemorrhagic deaths remains the greatest contributor to chemotherapy failure.…”