Haem and the Heart

Comment on the ECG. What is the most likely cause of the pain, and what other abnormalities are present?

The patient’s troponin is resulted at 0.17ng/ml (normal range < 0.07) and his repeat ECG shows deepening lateral T wave inversion. You diagnose an acute coronary syndrome.

How might you stratify his risk to guide further management?

The patient’s GRACE score was 156, giving 24% 6-month mortality. He was loaded with aspirin and clopidogrel, and after discussion with cardiology and haematology, also continued on warfarin and anagrelide. Three days later a tight LAD occlusion was stented.

3. Give 2 common clinical manifestations of essential thrombocythaemia