melphalan and Angina-Pectoris

The described report deals with the case of a patient with diagnosis of ischemic-hypertensive cardiomyiopathy based on the history of angina and inducible myocardial ischemia with normal coronary arteries. However, after cardiac magnetic resonance, the typical amyloidotic pattern is found and the final diagnosis of multiple myeloma is made at osteomedullary biopsy.

Topics: Amyloidosis; Angina Pectoris; Antineoplastic Agents, Alkylating; Biopsy; Bone Marrow Examination; Cardiomyopathies; Combined Modality Therapy; Diagnostic Errors; Dyspnea; Electrocardiography; Humans; Hypertrophy, Left Ventricular; Magnetic Resonance Imaging; Male; Melphalan; Middle Aged; Multiple Myeloma; Myocardial Ischemia; Peripheral Blood Stem Cell Transplantation

Effort angina due to left main trunk (LMT) lesion was diagnosed in a 58-year-old man. Platelet count was markedly increased and essential thrombocythemia was also diagnosed. Because of LMT disease, coronary artery bypass grafting (CABG) was performed prior to medication for essential thrombocythemia. There were no complications during the operation or in the early postoperative period. Melphalan was administered postoperatively resulting in the decrease of platelet count. Postoperative coronary angiography demonstrated that both grafts were patent; however, immediately after coronary angiography, the patient suffered from a sudden onset of myocardial infarction and cerebral infarction. The therapeutic problems associated with hematological disorder in such patients are discussed in this report.

Topics: Angina Pectoris; Cerebral Infarction; Coronary Angiography; Coronary Artery Bypass; Humans; Male; Melphalan; Middle Aged; Myocardial Infarction; Platelet Count; Postoperative Complications; Thrombocytosis; Vascular Patency

Topics: Aged; Angina Pectoris; Blood Protein Disorders; Blood Viscosity; Humans; Immunoglobulin G; Male; Melphalan; Myeloma Proteins; Plasmapheresis