Case report
Myocardial infarction in a patient with moderate haemophilia A

Introduction

Haemophilia A is a hereditary coagulation disorder with recessive X-linked mode of transmission. It is caused by decreased activity of factor VIII in plasma. Before the development of specific therapies most patients with haemophilia died during childhood or in early adulthood due to bleeding complications [1]. After the introduction of treatment with factor VIII substitutes the number of deaths caused by bleeding related to haemophilia dropped and the mean survival time of the patients increased [2]. Aging of the population of patients with haemophilia caused an increase in the frequency of age-related diseases including coronary disease [3]. Below, we describe a case of a patient with moderate haemophilia A and anterior wall myocardial infarction.

Case report

A 61-year-old male, a smoker, without a history of cardiovascular diseases, was admitted to the Cardiology Department of the Regional Hospital in the second hour of typical anginal chest pain. Medical history of the patient included haemophilia A, hepatitis C and prior gastric resection due to duodenal ulcer. The patient was diagnosed with a moderate form of haemophilia (5% of factor VIII activity and no antibodies against factor VIII). During childhood the patient suffered from frequent spontaneous intra-arterial haemorrhages which in consequence led to arthropathy. Haemorrhages decreased spontaneously after 30 years of age. The patient received only one infusion of factor VIII concentrate due to tooth extraction 1.5 years before the present hospitalization. On admission he was in moderate general condition and had stenocardia. On physical examination he had pale skin and contractures of the cubital, knee and hip joints. Blood pressure was 125/90 mmHg, heart rhythm 75 bpm. There were no signs or symptoms of heart failure. ECG showed 2 mm high ST-segment elevation in leads V2-V4. Echocardiography performed on the day of admission demonstrated apical hypokinesis with ejection fraction of 50%. Laboratory examinations on admission showed microcytic anaemia (Hgb 8.6 g/dl, Hct 31.1%, RBC 4.81 × 106/µl, MCV 64.7 fl), prolonged APTT of 60.7 sec, hypercholesterolaemia (total cholesterol 209 mg/dl, LDL 147.8 mg/dl, triglycerides 80 mg/dl). Due to anaemia the patient underwent surgical consultation, but no signs of active gastrointestinal bleeding were found. The patient refused coronary angiography and therefore conservative treatment was started. He received 300...


View full text...