An unusual cause of unstable angina pectoris in a health technician: autophylebotomy.

To the Editor: A 56-year-old male health technician presented with fatigue and unstable angina pectoris. He had obesity, hypertension and a smoking habit as risk factors for coronary artery disease. EKG showed biphasic T waves in leads V2 through V6 (Fig. A). In the laboratory analysis, his hemoglobin value was 7 g/dL. On detailed questioning, his relatives stated that for the last 2 to 3 years, the patient had regularly drawn his own blood (20-30 mL) every week and thrown it away, with the belief that he had too much blood, and it was bad for his health. Coronary angiography, which was performed after increasing the hemoglobin value to >10 mg/dL with blood transfusions, showed normal coronary arteries. His symptoms ceased, and T waves became positive (Fig. B) with blood transfusions.

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Unstable angina pectoris developing in the presence of an extracardiac condition that intensifies myocardial ischemia is called secondary angina. (1) Autophylebotomy as a cause of secondary angina pectoris, to our knowledge, has never been reported.

Although it is well documented that a common cause of angina pectoris is anemia, our case is unusual because the cause of the anemia was autophylebotomy, and even more unusual because it was performed by a health technician.

Mehmet Ozaydin, MD

Yasin Turker, MD

Ercan Varol, MD

Department of Cardiology

School of Medicine, Suleyman Demirel

University

Isparta State Hospital

Isparta, Turkey

Reference

1. Cannon CP, Braunwald E. Unstable angina and non-ST elevation myocardial infarction. In: Zipes DP, Libby P, Bonow R, Braunwald E (eds). Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 7th ed. Philadelphia, Elsevier Saunders, 2005, p 1243.