Myocardial Infarction in Polycythemia Vera and Dengue: A Case of Competing Risks

Area of Science:

• Cardiology
• Infectious Diseases
• Hematology

Background:

• A 71-year-old male with polycythemia vera and prior myocardial infarction presented with symptoms suggestive of acute coronary syndrome.
• The patient also had an acute dengue infection, complicating his cardiovascular presentation.

Observation:

• Electrocardiography showed ischemic changes and elevated troponin T, while NS1 antigen testing confirmed dengue infection.
• Laboratory results revealed erythrocytosis, mild thrombocytopenia, and worsening renal function.

Findings:

• The patient was diagnosed with myocardial infarction secondary to polycythemia vera-induced hypercoagulability and dengue-associated thrombocytopenia.
• Due to high bleeding risk and spontaneous symptom resolution, percutaneous coronary intervention was deferred.

Implications:

• This case illustrates the complex management challenges in patients with coexisting hypercoagulable states and infections causing thrombocytopenia.
• A multidisciplinary approach is crucial for optimizing outcomes in high-risk cardiovascular patients with overlapping conditions.