BMJ Case Reports 2018; doi:10.1136/bcr-2017-220723
  • Unexpected outcome (positive or negative) including adverse drug reactions

Ventricular tachyarrhythmia in a 78-year-old woman with essential thrombocythaemia

  1. Allan Greenspan2
  1. 1Internal Medicine, Einstein Medical Center, Philadelphia, Pennsylvania, USA
  2. 2Division of Cardiac Electrophysiology, Einstein Medical Center, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Mary Rodriguez-Ziccardi, RodrigMa{at}
  • Accepted 25 January 2018
  • Published 8 February 2018


Anagrelide is a phosphodiesterase-3 inhibitor used in the treatment of essential thrombocythaemia. Cardiovascular side effects such as ventricular tachycardia and cardiomyopathy are rare but potentially fatal and should be made known to patients before starting the medication. It usually arises within the first 6 months after initiation of therapy and may be dose related. The elderly population are particularly susceptible. These cardiotoxicities result from an increase in cyclic AMP that induces positive inotropic and chronotropic effects and are often reversible with cessation of use. We report a case of a 78-year-old woman with essential thrombocythaemia and recently started on anagrelide who presented with syncope and multiple bruises and facial trauma and found to have developed ventricular tachyarrhythmia.


  • Contributors MR-Z admitted and followed the patient on the cardiology service, participated in writing the case and review of the literature and development of the discussion and conclusion, got patient’s consent, responsible for the overall content and guarantor. MR also followed the patient on the cardiology service, also participated in reviewing the discussion and conclusion. ML: critical revision of the manuscript and final approval of the version to be published, was the senior resident managing the patient on the cardiology service. AG: attending taking care of the patient, also did the electrophysiology studies, critical revision of the discussion, revision of the final version.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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