Prinzmetal Angina in Major Hemophilia a Patient: A Case Report

Romaric Mahutondji Massi; Bienvenu Houssou; Marième Camara; Nisrine Khoubila; Asma Quessar; Bouchra Oukkache

doi:doi:10.11648/j.ajim.20150304.17

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Prinzmetal Angina in Major Hemophilia a Patient: A Case Report

Romaric Mahutondji Massi, Bienvenu Houssou, Marième Camara, Nisrine Khoubila, Asma Quessar, Bouchra Oukkache

Published in American Journal of Internal Medicine (Volume 3, Issue 4)

Received: 4 July 2015 Accepted: 14 July 2015 Published: 31 July 2015

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Abstract

Introduction: Prinzmetal angina is a special type of acute coronary syndrome ST+ wich correspond to a transient occlusion of a coronary vessel secondary to spasm. This type of acute coronary syndrome is very rare and is characterized by the presence of signs of myocardial ischemia on electrocardiogram but coronary angiography and coroscaner are frequently normals. Its management in hemophilia patients is difficult because of the use of anticoagulant and antiplatelet drugs wich increase bleeding risk. We report the case of a major hemophilia A patient which presented Prinzmetal angina. Observation : It is a 64 years old patient, hemophilia A major, chronic smoking (40 pack-year), not diabetic, not hypertensive, which had a retro sternal constrictive pain radiating to the shoulders. At admission he was consciousness. No breath in cardiac auscultation. The electrocardiography showed a heart rate at 61bpm, the axis of the heart was normal. ST-segment elevation was noticed in DIII and AVF : ischemia in the cardiac lower area. Echocardiography was normal. The coroscaner was normal. The troponin I level was at 0.03 µg / L (Normal : 0-0.1µg/L). This patient had a variant Prinzmetal angina. Treatement: Diltiazem Hydrochloride 60 mg 1 tablet / 8 hours. Acetylsalicylic acid 160 mg IV and Clopidogrel 300 mg IV the first day ; relay with acetylsalicylic acid 100 mg and clopidogrel 75 mg per day. Transfusion of factor VIII at the dose of 40UI / Kg. Simvastatin 20 mg 1 tablet per day. Perindopril 5 mg 1 tablet the day. The evolution was favorable. Discussion and conclusion: Coronary syndromes are not frequent in morocco hemophilia patients. Their management is complex and involves the presence of an hematologist.

Published in	American Journal of Internal Medicine (Volume 3, Issue 4)
DOI	10.11648/j.ajim.20150304.17
Page(s)	194-196
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2015. Published by Science Publishing Group

Keywords

Acute Coronary Syndrome, Hemophilia, Management

References

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[2]	Cayla G, Morange PE, Chambost H, Schved JF. Hémophilie et pathologies cardiovasculaires. AMC pratique. Hors-série 1. Juin 2010 : 1-3
[3]	Kulkarni R, Soucie JM, Evatt BL, Hemophilia Surveillance System Project Investigators. Prevalence and risk factors for heart disease among males with hemophilia. Am J Hematol 2005;79:36-42.
[4]	Prinzmetal M, Kennamer R, Merliss R, et al. Angina pectoris. A variant form of angina pectoris; preliminary report. Am J Med. 1959;27:375e388.
[5]	Chahine RA, Raizner AE, Ishimori T, et al. The incidence and clinical implications of coronary artery spasm. Circulation. 1975;52:972e978.
[6]	Feliciano L, Henning R. Coronary artery blood flow: physiologic and pathophysiologic regulation. Clin Cardiol 1999;22:775 – 86.
[7]	Kelm M, Schrader J. Control of coronary vascular tone by nitric oxide. Circ Res 1990;66:1561 – 75.
[8]	Bassand JP, Hamm CW, Ardissino D et al. Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes. Eur Heart J. 2007;28:1598-660.
[9]	Van de Werf F, Bax J, Betriu A et al. Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the Task Force on the Management of ST-Segment Elevation Acute Myocardial Infarction of the European Society of Cardiology. Eur Heart J 2008;29:2909-45.
[10]	Staritz P, de Moerloose P, Schutgens R, Dolan G. Applicability of the European Society of Cardiology guidelines on management of acute coronary syndromes to people with haemophilia - an assessment by the ADVANCE Working Group. Haemophilia. 2013 Nov;19(6):833-40.
[11]	Fogarty PF, Mancuso ME, Kasthuri R, Bidlingmaier C, Chitlur M, Gomez K, et al. Presentation and management of acute coronary syndromes among adult persons with haemophilia: result of an international, retrospective, 10-years survey. Haemophilia. 2015 Feb 17. Doi: 10. 1111/hae.12652.
[12]	Mannucci PM. Management of antithrombotic therapy for acute coronary syndromes and atrial fibrillation in patients with hemophilia. Expert Opin Pharmacother 2012;13: 505-10.
[13]	Anderson JL, Adams CD, Antman ME, Bridges CH, Califf RM, Donald E, et al. 2012 ACCF/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2013; 127: e663-828.

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APA Style

Romaric Mahutondji Massi, Bienvenu Houssou, Marième Camara, Nisrine Khoubila, Asma Quessar, et al. (2015). Prinzmetal Angina in Major Hemophilia a Patient: A Case Report. American Journal of Internal Medicine, 3(4), 194-196. https://doi.org/10.11648/j.ajim.20150304.17

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ACS Style

Romaric Mahutondji Massi; Bienvenu Houssou; Marième Camara; Nisrine Khoubila; Asma Quessar, et al. Prinzmetal Angina in Major Hemophilia a Patient: A Case Report. Am. J. Intern. Med. 2015, 3(4), 194-196. doi: 10.11648/j.ajim.20150304.17

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AMA Style

Romaric Mahutondji Massi, Bienvenu Houssou, Marième Camara, Nisrine Khoubila, Asma Quessar, et al. Prinzmetal Angina in Major Hemophilia a Patient: A Case Report. Am J Intern Med. 2015;3(4):194-196. doi: 10.11648/j.ajim.20150304.17

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@article{10.11648/j.ajim.20150304.17,
  author = {Romaric Mahutondji Massi and Bienvenu Houssou and Marième Camara and Nisrine Khoubila and Asma Quessar and Bouchra Oukkache},
  title = {Prinzmetal Angina in Major Hemophilia a Patient: A Case Report},
  journal = {American Journal of Internal Medicine},
  volume = {3},
  number = {4},
  pages = {194-196},
  doi = {10.11648/j.ajim.20150304.17},
  url = {https://doi.org/10.11648/j.ajim.20150304.17},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20150304.17},
  abstract = {Introduction: Prinzmetal angina is a special type of acute coronary syndrome ST+ wich correspond to a transient occlusion of a coronary vessel secondary to spasm. This type of acute coronary syndrome is very rare and is characterized by the presence of signs of myocardial ischemia on electrocardiogram but coronary angiography and coroscaner are frequently normals. Its management in hemophilia patients is difficult because of the use of anticoagulant and antiplatelet drugs wich increase bleeding risk. We report the case of a major hemophilia A patient which presented Prinzmetal angina. Observation : It is a 64 years old patient, hemophilia A major, chronic smoking (40 pack-year), not diabetic, not hypertensive, which had a retro sternal constrictive pain radiating to the shoulders. At admission he was consciousness. No breath in cardiac auscultation. The electrocardiography showed a heart rate at 61bpm, the axis of the heart was normal. ST-segment elevation was noticed in DIII and AVF : ischemia in the cardiac lower area. Echocardiography was normal. The coroscaner was normal. The troponin I level was at 0.03 µg / L (Normal : 0-0.1µg/L). This patient had a variant Prinzmetal angina. Treatement: Diltiazem Hydrochloride 60 mg 1 tablet / 8 hours. Acetylsalicylic acid 160 mg IV and Clopidogrel 300 mg IV the first day ; relay with acetylsalicylic acid 100 mg and clopidogrel 75 mg per day. Transfusion of factor VIII at the dose of 40UI / Kg. Simvastatin 20 mg 1 tablet per day. Perindopril 5 mg 1 tablet the day. The evolution was favorable. Discussion and conclusion: Coronary syndromes are not frequent in morocco hemophilia patients. Their management is complex and involves the presence of an hematologist.},
 year = {2015}
}

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TY - JOUR
T1 - Prinzmetal Angina in Major Hemophilia a Patient: A Case Report
AU - Romaric Mahutondji Massi
AU - Bienvenu Houssou
AU - Marième Camara
AU - Nisrine Khoubila
AU - Asma Quessar
AU - Bouchra Oukkache
Y1 - 2015/07/31
PY - 2015
N1 - https://doi.org/10.11648/j.ajim.20150304.17
DO - 10.11648/j.ajim.20150304.17
T2 - American Journal of Internal Medicine
JF - American Journal of Internal Medicine
JO - American Journal of Internal Medicine
SP - 194
EP - 196
PB - Science Publishing Group
SN - 2330-4324
UR - https://doi.org/10.11648/j.ajim.20150304.17
AB - Introduction: Prinzmetal angina is a special type of acute coronary syndrome ST+ wich correspond to a transient occlusion of a coronary vessel secondary to spasm. This type of acute coronary syndrome is very rare and is characterized by the presence of signs of myocardial ischemia on electrocardiogram but coronary angiography and coroscaner are frequently normals. Its management in hemophilia patients is difficult because of the use of anticoagulant and antiplatelet drugs wich increase bleeding risk. We report the case of a major hemophilia A patient which presented Prinzmetal angina. Observation : It is a 64 years old patient, hemophilia A major, chronic smoking (40 pack-year), not diabetic, not hypertensive, which had a retro sternal constrictive pain radiating to the shoulders. At admission he was consciousness. No breath in cardiac auscultation. The electrocardiography showed a heart rate at 61bpm, the axis of the heart was normal. ST-segment elevation was noticed in DIII and AVF : ischemia in the cardiac lower area. Echocardiography was normal. The coroscaner was normal. The troponin I level was at 0.03 µg / L (Normal : 0-0.1µg/L). This patient had a variant Prinzmetal angina. Treatement: Diltiazem Hydrochloride 60 mg 1 tablet / 8 hours. Acetylsalicylic acid 160 mg IV and Clopidogrel 300 mg IV the first day ; relay with acetylsalicylic acid 100 mg and clopidogrel 75 mg per day. Transfusion of factor VIII at the dose of 40UI / Kg. Simvastatin 20 mg 1 tablet per day. Perindopril 5 mg 1 tablet the day. The evolution was favorable. Discussion and conclusion: Coronary syndromes are not frequent in morocco hemophilia patients. Their management is complex and involves the presence of an hematologist.
VL - 3
IS - 4
ER -

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Author Information

Romaric Mahutondji Massi

Departement of Biological Hematology of Ibn Rochd University Hospital, Casablanca, Morocco
Bienvenu Houssou

Departement of Biological Hematology of Ibn Rochd University Hospital, Casablanca, Morocco
Marième Camara

Departement of Biological Hematology of Ibn Rochd University Hospital, Casablanca, Morocco
Nisrine Khoubila

Departement of Clinical Hematology and Pediatric Oncology of Ibn Rochd University Hospital, Casablanca, Morocco
Asma Quessar

Departement of Clinical Hematology and Pediatric Oncology of Ibn Rochd University Hospital, Casablanca, Morocco
Bouchra Oukkache

Departement of Biological Hematology of Ibn Rochd University Hospital, Casablanca, Morocco

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APA Style

Romaric Mahutondji Massi, Bienvenu Houssou, Marième Camara, Nisrine Khoubila, Asma Quessar, et al. (2015). Prinzmetal Angina in Major Hemophilia a Patient: A Case Report. American Journal of Internal Medicine, 3(4), 194-196. https://doi.org/10.11648/j.ajim.20150304.17

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ACS Style

Romaric Mahutondji Massi; Bienvenu Houssou; Marième Camara; Nisrine Khoubila; Asma Quessar, et al. Prinzmetal Angina in Major Hemophilia a Patient: A Case Report. Am. J. Intern. Med. 2015, 3(4), 194-196. doi: 10.11648/j.ajim.20150304.17

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AMA Style

Romaric Mahutondji Massi, Bienvenu Houssou, Marième Camara, Nisrine Khoubila, Asma Quessar, et al. Prinzmetal Angina in Major Hemophilia a Patient: A Case Report. Am J Intern Med. 2015;3(4):194-196. doi: 10.11648/j.ajim.20150304.17

Copy | Download

@article{10.11648/j.ajim.20150304.17,
  author = {Romaric Mahutondji Massi and Bienvenu Houssou and Marième Camara and Nisrine Khoubila and Asma Quessar and Bouchra Oukkache},
  title = {Prinzmetal Angina in Major Hemophilia a Patient: A Case Report},
  journal = {American Journal of Internal Medicine},
  volume = {3},
  number = {4},
  pages = {194-196},
  doi = {10.11648/j.ajim.20150304.17},
  url = {https://doi.org/10.11648/j.ajim.20150304.17},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20150304.17},
  abstract = {Introduction: Prinzmetal angina is a special type of acute coronary syndrome ST+ wich correspond to a transient occlusion of a coronary vessel secondary to spasm. This type of acute coronary syndrome is very rare and is characterized by the presence of signs of myocardial ischemia on electrocardiogram but coronary angiography and coroscaner are frequently normals. Its management in hemophilia patients is difficult because of the use of anticoagulant and antiplatelet drugs wich increase bleeding risk. We report the case of a major hemophilia A patient which presented Prinzmetal angina. Observation : It is a 64 years old patient, hemophilia A major, chronic smoking (40 pack-year), not diabetic, not hypertensive, which had a retro sternal constrictive pain radiating to the shoulders. At admission he was consciousness. No breath in cardiac auscultation. The electrocardiography showed a heart rate at 61bpm, the axis of the heart was normal. ST-segment elevation was noticed in DIII and AVF : ischemia in the cardiac lower area. Echocardiography was normal. The coroscaner was normal. The troponin I level was at 0.03 µg / L (Normal : 0-0.1µg/L). This patient had a variant Prinzmetal angina. Treatement: Diltiazem Hydrochloride 60 mg 1 tablet / 8 hours. Acetylsalicylic acid 160 mg IV and Clopidogrel 300 mg IV the first day ; relay with acetylsalicylic acid 100 mg and clopidogrel 75 mg per day. Transfusion of factor VIII at the dose of 40UI / Kg. Simvastatin 20 mg 1 tablet per day. Perindopril 5 mg 1 tablet the day. The evolution was favorable. Discussion and conclusion: Coronary syndromes are not frequent in morocco hemophilia patients. Their management is complex and involves the presence of an hematologist.},
 year = {2015}
}

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