Vnitr Lek 2005, 51(9):1007-1010

Noncomplicated course of hypertension, paroxysmal atrial fibrillation and essential thrombocytaemia

J. Pella^1,*, P. Kalist¹, J. Lazúr²

¹ III. interná klinika Lekárskej fakulty UPJŠ a FN L. Pasteura, Košice, Slovenská republika, prednosta prof. MUDr. Jozef Pella, Ph.D.

² Hematologické oddelenie FN L. Pasteura, Košice, Slovenská republika, prednosta prim. MUDr. Ján Lazúr

In the case report we describe more than 17-year long monitoring and treatment of 79-year-old woman patient. In spite of progressive increase of number of diseases (altogether 6), each being associated with increased risk of thromboembolic (alternatively haemorrhagic) events, the history was without complications up to now. Hypertension, diagnosed in the year of 1987, was the first disease we monitored and treated with calcium channel blocker (CCB - verapamil). Patient experienced the first paroxysm of atrial fibrillation (PAF) in the year of 1997. This paroxysm was managed by application of propaphenone in combination with acetylsalicylic acid in daily oral dose of 300 mg. We detected essential thrombocytaemia (ET) in the year of 1999. Maximum thrombocyte count (Tr) did not exceed the value 1 000 × 10⁹/l. In respect to the age and associated diseases we started to administer also cytoreductive treatment with hydroxyurea (Litalir) in addition to the treatment with acetylsalicylic acid mentioned above. The last 4 years we diagnosed diffuse osteoporosis with positive LATEX titre (1 : 40). Mild primary hypothyroidism was substituted by levothyroxine (Euthyrox). Because of dyspeptic complaint verified gastroscopically in the year of 2002 (small aphthous lesions in gastric antrum) we replaced acetylsalicylic acid with ticlopidine, which is less aggressive to gastric mucosa and which was subjectively better tolerated by the patient. In the year of 2004 repeated gastroscopy confirmed complete cure of aphthous changes (virtually normal finding). Seven years after the first attack (that was also the last one) of PAF the patient is still without atrial fibrillation (AF). At present she is subjectively without complaint, objective findings - blood pressure (BP), blood cell count, liver function tests are normal. In the literature we have not found the case of the above mentioned combination of 6 diseases without embolic and haemorrhagic complications.

Keywords: hypertension; atrial fibrillation; essential thrombocytaemia

Received: April 26, 2004; Accepted: January 13, 2005; Published: September 1, 2005  Show citation