Introduction: The cause of chest pain in patients presenting to the emergency room often remains unclear. We present a case of essential thrombocythemia as a novel cause of atypical chest pain, which responded dramatically to a simple treatment intervention. Case presentation: A 54-year-old patient presenting with atypical chest pain was found to have essential thrombocythemia as a cause for her chest pain. She responded dramatically to aspirin therapy and had no recurrence of symptoms over 3 months. Conclusion: Essential thrombocythemia should be considered as a differential cause in patient presenting with atypical chest pain, vasomotor symptoms and high platelet counts. These symptoms are generally more bothersome than dangerous and are usually controlled by low dose aspirin therapy.
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