Ventricular electrical storm after acute myocardial infarction in a patient with polycythemia vera: case report

Abstract

Background: Ventricular electrical storm (VES) is a medical emergency defined by three or more episodes of sustained ventricular tachyarrhythmias within 24 hours, often requiring defibrillation or electrical cardioversion. Although rare, it is associated with high in-hospital mortality, particularly in patients with structural heart disease, ventricular dysfunction, and acute myocardial infarction (AMI), in which ischemia and myocardial fibrosis promote the formation of arrhythmogenic foci. Polycythemia vera, by increasing the risk of thrombosis and AMI due to hyperviscosity, may indirectly contribute to the onset of VES.

Aim: To report a case of VES following AMI in a patient with polycythemia vera treated in our Service.

Methodology: This study presents the case of a patient admitted to the Intensive Care Unit of the Hospital Universitário São Francisco na Providência de Deus (HUSF), in Bragança Paulista, SP, Brazil.

Case Report: We describe the case of a 44-year-old male, hypertensive and smoker, admitted with inferior acute myocardial infarction, who presented multiple episodes of ventricular fibrillation reversed with defibrillation. Coronary angiography revealed occlusion of the right coronary artery, treated with balloon angioplasty, drug-eluting stent implantation, and manual thrombectomy, with the additional use of an intra-aortic balloon pump due to the severity of the condition. After 30 days in the intensive care unit, the patient showed satisfactory recovery and was discharged, when a previous diagnosis of polycythemia vera was confirmed, explaining the high thrombotic burden observed.

Conclusion: This report contributes to broadening the understanding of the diverse clinical scenarios in which VES may occur, highlighting the importance of clinical vigilance and timely interventions to reduce morbidity and mortality.