TROJAN HEARTBEATS: ACUTE MYELOID LEUKEMIA DISGUISED AS ACUTE CORONARY SYNDROME

Document Type

Conference Proceeding

Publication Date

4-1-2024

Publication Title

J Am Coll Cardiol

Abstract

Background Leukostasis, a manifestation that affects 15% of acute myeloid leukemia (AML) patients, with rare cardiac involvement including myocardial ischemia, arrhythmias, and pericarditis. We discuss an AML case resembling acute coronary syndrome (ACS) due to leukostasis-induced myocardial ischemia. Case A 52-year-old female, presents to the ED with acute chest pain. EKG indicated t-wave inversions in leads II, V5, V6 and 1 mm ST elevations in leads 1, aVL. Troponins surged to 371 ng/L. Laboratory findings highlighted WBC at 211,000 cell/uL, constituting 83% blasts. Peripheral smear revealed a diagnosis of acute myeloid leukemia (AML) accompanied by pronounced leukocytosis. Decision-making An echocardiogram was performed and revealed a normal left ventricular function without wall motion abnormalities. Furthermore, a coronary angiography showed no evidence of obstructive pathologies or stenotic lesions. In light of the newly established diagnosis of AML, in conjunction with a pristine echocardiogram and a normal coronary angiography, leukostasis was identified as the trigger for the ACS. Immediate leukapheresis and Hydroxyurea administration led to a WBC count reduction to 30,000 cells/μL, subsequently alleviating the angina and EKG changes. [Formula presented] Conclusion ACS can be a rare presentation of AML. Prompt leukapheresis can effectively clear microvascular blockages. Our experience with this patient highlights the importance of recognition of an uncommon presentation of acute leukemia.

Volume

83

Issue

13

First Page

4371

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